COORDINATION WITH HMDOs

1. COORDINATION WITH HMDOs [ENTER FACILITATOR’S NAME AND CONTACT INFORMATION] Developed by Troutman Sanders LLP Developed for the Virginia Department of Health Funded by Centers for Disease Control and Prevention

3. Toolkit Presentations Instructions for Use • Toolkit Presentations are intended to be a companion to the HospitalImplementation Guide and should not be used in isolation. • The Presentations are intended to serve as a starting point for the facilitator. The facilitator should thoroughly review the Presentation prior to use in Implementation Team, CRAG or Subcommittee meetings and customize the Presentation to meet the unique needs of the meeting participants. • Pay particular to attention to the information provided in brackets ([ ]), which must be completed by the facilitator prior to use. • Included in the “Notes” section of each slide are the following types of information: • Slide Type, which indicates whether the slide is for information or discussion, serves as a placeholder, or is some combination thereof • Planning Guide Section(s), which will direct the facilitator to the corresponding sections of the Planning Guide and HospitalImplementation Guide for further information • Special Instructions, which provides directions for the facilitator to customize the slide for the intended audience • Speaker’s Notes, which provides more detailed information to supplement the material on the slide • Refer to the Hospital Implementation Guide for further guidance and helpful hints on effectively completing the process described in the Planning Guide.

4. CRAG Members • [Enter names and departments of each CRAG member]

5. Add slides from Altered Standards Overview and/or Chapter 1 presentation, as needed, to re-introduce the CRAG to the concept of altered standards and critical resource shortage response planning, especially if new members are involved.

6. Introduction

7. Chapter Overview • Identify HMDOs for coordination • Create a communication strategy with other HMDOs • Understand how HMDOs’ responses to the CRSE will impact other HMDOs • Engage in discussions regarding changes to scope of services • Expansion of scope • Reduction of scope • Discuss cooperative initiatives with other HMDOs • Establish parameters regarding “essential documentation”

8. Coordination During “Normal” Times

9. Patient Care in CRSE Without Coordinated Planning • Smaller degree of overlap • Each will retreat into its own silo and implement its own “disaster plan” “Non-Productive Interaction”

10. Patient Care in CRSE With Coordinated Planning • Higher degree of overlap • Both entities will rely on each other to do more “Productive Interaction”

11. Patient Care in CRSE With Coordinated Planning What exactly does this coordination look like during a CRSE?

12. Decisions for the Planning Unit • With which HMDOs are we going to coordinate? • How are we going to coordinate with the selected HMDOs? • Will we expect these HMDOs to change their scope of services to support our response to the CRSE? If so, how? • Are there any cooperative initiatives that we want to pursue with other HMDOs? • What problems, if any, do we see with “essential documentation” between the hospital(s) in the Planning Unit and HMDOs?

13. Selecting HMDOs for Coordination

14. Selecting HMDOs for Coordination • There are a vast number of other HMDOs in the [Planning Unit] • It will be difficult to coordinate with each type of HMDO • It will be almost impossible to coordinate with individual HMDOs (e.g., each EMS provider) • The CRAG will have to prioritize types of HMDOs for coordination efforts

15. EMS Providers Community Physicians Ambulatory Surgery Centers Home Health Assisted Living Long Term Care Dialysis Facilities Community Health Centers FQHCs Hospice Outpatient Lab Infusion Centers Outpatient Imaging Rehabilitation Hospitals Alternate Care Facilities Other Acute Care Facilities Pharmacy Brainstorm a List of Other HMDOs

16. Prioritize the HMDOs for Coordination • Which HMDOs may be able to help protect the hospital(s) in the Planning Unit from being overwhelmed during a CRSE by providing certain types of care or early triage? • Which HMDOs may pose a risk to hospital(s) in the Planning Unit during a CRSE because they have the potential to transfer large numbers of patients to the hospital(s)?

17. Prioritizing HMDOs for Coordination

18. Coordination Strategy

19. Coordination Considerations • HMDO representative bodies v. each individual HMDO • CRAG v. selected representative(s) of the CRAG • Methods of communication with the HMDOs

20. Representative Body v. Individual HMDOs

21. CRAG v. Representative(s) of the CRAG

22. Communication Methods

23. Scope of Services

24. Changes to Scope of Services • HMDOs may be planning to change their scope of services as part of their critical resource shortage response plans • The Planning Unit’s CRSRP and associated Protocols may be more effective if other HMDOs change their scope of services • Expansion • Reduction

25. CRSRP and Associated Protocols • Ethical framework • Operational infrastructure • Protocols • [LIST ALL RESOURCE-SPECIFIC PROTOCOLS] • Ad Hoc Protocol Development Infrastructure • Evaluation and Maintenance • Approval and Integration • Communication

26. EXPANSION • [Can any care be performed by other HMDOs to provide relief to the hospital(s) in the Planning Unit?] • [Can any additional testing or services be performed at other HMDOs to facilitate the hospital’s implementation of Protocols?]

27. REDUCTION • [Is there any care that may be provided by other HMDOs that will negatively impact a hospital’s ability to implement a Protocol?] • [If so, does it make sense to ask these other HMDOs to limit this type of care?]

28. Other Collaboration Issues

29. Are there any cooperative initiatives that we want to pursue with other HMDOs? • Cooperative stockpiling • Ambulance re-stocking • SNS distribution • Alternate care facility

30. What problems, if any, do we see with “essential documentation” between the hospital(s) in the Planning Unit and HMDOs? • [INSERT DEFINITION OF “ESSENTIAL DOCUMENTATION” FROM SECTION 4.5]

31. What documentation is used today? Is all of today’s documentation necessary during a CRSE? What is the minimum amount of information needed? What information is needed for reimbursement purposes? “Essential Documentation” between the Hospital(s) in the Planning Unit and HMDOs Essential Documentation

32. BREAK

33. HMDO Coordination

34. Summary of Discussions with HMDOs • [WHICH HMDOs WERE CONTACTED] • [NUMBER AND TYPES OF COMMUNICATIONS/MEETINGS] • [PARTICIPANTS IN DISCUSSIONS] • [GENERAL TOPICS OF COMMUNICATIONS/MEETINGS]

35. HMDO Response to a CRSE • HMDO’s response is designed to support its continuity of operations • [DETAILS REGARDING HMDO’S CRITICAL RESOURCE SHORTAGE RESPONSE PLAN, IF ANY] • [CHANGES TO SCOPE OF SERVICES] • [ASSUMPTIONS THAT HMDO IS MAKING ABOUT THE HOSPITAL(S) IN THE PLANNING UNIT]

36. HMDO Response to a CRSE • [PRELIMINARY CONCLUSIONS ABOUT IMPACT THAT HMDO RESPONSE TO A CRSE WILL HAVE ON THE HOSPITAL(S) IN THE PLANNING UNIT]

37. HMDO’s Willingness to Change its Scope of Services • [SUMMARY OF THE “ASK” – HOW DID THE CRAG WANT THE HMDO TO CHANGE ITS SCOPE OF SERVICES TO SUPPORT THE PLANNING UNIT’S CRSRP AND ASSOCIATED PROTOCOLS?] • [SUMMARY OF THE HMDO’S RESPONSE]

38. HMDO’s Willingness to Change its Scope of Services • [PRELIMINARY CONCLUSIONS ABOUT IMPACT THAT HMDO’S RESPONSE TO REQUEST TO CHANGE ITS SCOPE OF SERVICES WILL HAVE ON THE HOSPITAL(S) IN THE PLANNING UNIT]

39. HMDO’S Interest in Pursuing Cooperative Initiatives • [SUMMARY OF PROPOSED INITIATIVES] • [SUMMARY OF HMDO’S INTEREST IN PURSUING SUGGESTED COOPERATIVE INITIATIVES] • [HMDO’S CONCERNS ABOUT COOPERATIVE INITIATIVES]

40. HMDO’s Ability to Provide “Essential Documentation” • [CHANGES THAT THE HMDOs ARE PLANNING TO MAKE TO THEIR DOCUMENTATION DURING A CRSE] • [SUMMARY OF COMPONENTS OF “ESSENTIAL DOCUMENTATION” FOR HMDO THAT CRAG IDENTIFIED] • [ABILITY TO SUPPORT THE SUGGESTED COMPONENTS OF “ESSENTIAL DOCUMENTATION” AS IDENTIFIED BY THE CRAG]

41. HMDO’s Ability to Provide “Essential Documentation” • [PRELIMINARY CONCLUSIONS ABOUT THE IMPACT THAT HMDO’S ABILITY TO SUPPORT COMPONENTS OF “ESSENTIAL DOCUMENTATION” WILL HAVE ON THE HOSPITAL(S) IN THE PLANNING UNIT]

42. Next Steps in Coordination with HMDOs • [Preliminary suggestions for next steps in the coordination effort with other HMDOs]

43. Modifications to CRSRP or Associated Protocols • [Preliminary suggestions for modifying the CRSRP or associated Protocols as a result of the coordination among the hospital(s) in the Planning Unit and HMDOs]

44. Questions?