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Creating Hospital Surge Capacity: Hospital Functions and Reallocation of Resources.
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Creating Hospital Surge Capacity: Hospital Functions and Reallocation of Resources THIRD NATIONAL EMERGENCY MANAGEMENT SUMMITThe Leading Forum on Disaster, Epidemic and Terrorism Planning, Response and Recovery for Healthcare OrganizationsRenaissance Washington DC HotelWashington, DCMarch 4 - 6, 2009
Presentation Objectives Identify hospital functions critical to the maintenance and creation of surge capacity Identify a potential method for closing gaps in medical surge demands Identify a scalable method able to meet the demands of different types of incidents, adaptable to a variety of hospital sizes and configurations and consistent with CDC, ASPR, OSHA, CMS and The Joint Commission standards and guidelines
Introduction Efforts to contain the economic burden of healthcare in the United States have resulted in improved efficiency in hospital operations In part, these efficiencies have been obtained by reducing bed capacity, running near maximum hospital capacity and adjusting resources including staffing ratios Healthcare systems are now being charged with the task of increasing surge capacity to accommodate an influx of patients requiring triage and emergent care with little or no advance warning The purpose of the Hospital Emergency Support Functions Project is to identify staff capabilities and capacity available throughout the hospital that might be reassigned to both clinical and non-clinical services
Mandate Hospitals have been tasked by federal funding mandates and accreditation (The Joint Commission to the numbers of patients) to increase their in-house bed surge capacity, identify and establish plans for additional “alternate care” sites and facilities
Background Photo credit: LSU, Jon Best Large scale disasters such as hurricane Katrina have drawn attention to the need for medical surge capacity Ironically, it is this surge capacity that was eliminated in order to maximize efficiency Within a hospital environment there are multiple departments with staff that are capable and competent to provide cross coverage to other areas of the hospital where their expertise may be utilized during a large scale surge incident
Challenges Surge needs associated with a pandemic are among the most challenging given that surge capacity would likely be depleted No clear means have been established to determine staff suitably to care for this increased patient load Need for sustainability of staff for an extended period of time as seen in a pandemic event
Challenges Emergency Credentialing Program To date, plans nationwide have identified volunteerism and emergency credentialing systems as possible solutions to the staffing issue, however, no evidence has been shown that this approach will appropriately address the staffing needs in a large scale surge incident Commonly, hospital disaster plans rely on external sources to maintain surge capabilities and create additional capacity External mechanisms include alternate care sites, patient transfers, volunteerism and special disaster medical assistance teams
Assumptions A large-scale surge incident including, but not limited to a pandemic event, will likely dramatically decrease the available workers in all departments of the hospital During a large-scale surge incident certain hospital services will be cancelled Departments within the hospital may be combined to perform functions required by the particular surge incident that extends over multiple operational periods Staff may be reassigned and function competently within their field of expertise with applicable just-in-time training
Assumptions External assistance is unlikely to be available to hospitals in national catastrophes such as a pandemic Employee illness, care for family members, and fear of contracting serious illness may drive hospital absenteeism rates to 40% while need for services may increase well above the norm Prudent hospital planning must include internal mechanisms for increasing capacity and maintaining capability
Scope The Hospital Emergency Support Functions Project will identify personnel capabilities and capacity available throughout the hospital that may be reassigned to both clinical and non-clinical services during an event that causes a surge of patients and/or as a result of diminished personnel capacity Within each department, staff functions will be identified and categorized in order to create an all-inclusive database This database will be utilized during a large scale surge event to identify staff positions that may be reassigned to support the care of patients and maintain the hospital’s functional capability
HESF Categories • The Hospital Emergency Support Functions Project identified the following as essential functions of hospitals: • Patient Care • Staff • Facilities • Communications • Safety/Security • Business Continuity
HESF Categories To fulfill the essential functions of the hospital, 15 “Hospital Emergency Support Functions” (HESFs) were identified as follows: Clinical Services Clinical Support Services Emergency Family and Staff Support Nutrition Services Mortuary Services Maintenance, Engineering and Energy Resource Support and Materials Management Communications and Information Technology Public Information Transportation Safety Security Information and Planning Finance Human Resources
Policies for Consideration Who will authorize the implementation of the Hospital Emergency Support Functions (HESF) in response operations Who coordinates the assessment of staffing needs across all patient care areas In conjunction with ICS/HICS who authorizes the use of support department’s to augment clinical and non-clinical operations Role of Labor Pool Unit Leader
Next Steps • Gain approval of the HESF process from: • Legal • Human Resources • Senior Administration • Emergency Management Committee • Collaboration with Human Resources and Hospital Information Technology on the modification of the applicable databases to include assignment of “primary” or “secondary” to each work unit identified in the database • Identify appropriate members of HICS/ICS with access to the database
Next Steps • Develop and test process by which identification and reassignment tracking will be accomplished • Prepare user’s manual – “Using the HRDB in an Emergency Response” • Provide identified members of HICS/ICS with training in the use of the database • Design and develop an exercise testing the utility of the database to identify staff for transfer during a medical surge event
Contact Information James L. Paturas, CEM, EMTP, CBCP, FACCP Deputy Director (203) 688-3224 james.paturas@ynhh.org Yale New Haven Center for Emergency Preparedness and Disaster Response1 Church Street, 5th Floor New Haven, CT 06510www.yalenewhavenhealth.org/emergency
