Leslie A' Nieves and Scott R' Filer

1
FINDINGS FROM APPLYING A SYSTEMS-BASED PLANNING
TOOL TO HOSPITAL PREPAREDNESS FOR INFECTIOUS
DISEASE OUTBREAKS

• Leslie A. Nieves and Scott R. Filer
• April 21, 2004
• Decision and Information Sciences Division

2
Medical Care Planning Post 9/11 Terrorist Threat
Necessitates Redefining Focus

• Change from
• emphasis on local mass casualty events and
  facility system failures
• Change to
• Planning for bio-outbreaks, hazardous chemicals,
  and radioactive materials
• Planning for regional coordination of resources

3
Introducing Systems-Based Planning Techniques to
Medical Care Emergency Planning

• History of successful use in military and
  civilian emergency planning
• Supported by U.S. Army and FEMA

• Adapted techniques for application to medical
  response planning
• Conducted pilot test in one major medical center
  (2003)
• Applied to urban public health department (2003)
• Currently implementing with four major medical
  centers

4
What is Systems-Based Planning?

• Frames emergency response as a set of activity
  systems
• Considers
• goals,
• objectives to achieve the goals, and
• specific actions that must be taken

5
Systems-Based Planning Answers Key Questions

• What must be done?
• Who does it?
• When?
• How long does it take?
• What resources are required?
• Personnel, laboratory, pharmaceuticals, and
  equipment from local, regional, or national
  sources?
• How do other actions link to this action?
• What must happen before this action can take
  place?
• What happens next?

6
Method of Implementing Systems-Based Planning

• Work with hospital staff to review and modify
  existing plans
• Employ systems-based planning software tool to
  chart activities
• Within a framework defined by categories of
  response functions and time
• Apply HEICS structure to hospital response plan
• Train staff through review process and tabletop
  exercises

7
Bio-Outbreak Planning is a Different Beast

• All public health emergencies require
• Prompt triage and initiation of treatment, and
• Surge capacity adaptations of facility, staff,
  and equipment.
• Mass trauma, hazardous chemical, and radiological
  public health emergencies generally have a linear
  event structure.

• Bio-outbreaks have a less predictable structure.
• Crisis points for a hospital may occur early or
  late in an outbreak.
• Planning must be flexible and modular.

8
Focus of Planning for Bio-Outbreak Events

• Need to plan for gradual capacity adjustments
• Cohort patients
• Augment staff
• Effective infection control practices are
  crucial.
• Protect medical care environment
• Protect and support staff
• Critical hospital systems and infrastructure
  arent guaranteed.
• Plan for adaptation and back-up acquisition.

9
Considerations in Planning for Capacity
Adjustments

• Patient Flow (in a highly communicable disease
  outbreak)
• Set up respiratory symptom triage area external
  to ER.
• Cohort in-patients by risk category (confirmed,
  suspect, not suspected).
• Augmenting staff
• Intensive use of PPE may raise numbers of medical
  care workers needed.

10
Considerations in Planning to Protect Medical
Care Environment

• Control entry of potentially contagious persons
• Facility access control
• Surveillance of inpatients and staff
• Risk screening of anyone requesting treatment
• Cohort patients by risk criteria
• Isolate patients with different risks in areas
  served by separate air handling systems
• Institute appropriate protective measures
• Minimize transport of high-risk patients for
  treatment

11
Considerations in Planning for Staff Support

• Provide for stress relief
• Establish rest and break areas
• Hold debriefings
• Offer counseling
• Minimize number of potentially exposed staff
• Monitor staff risks and staff health
• Provide for staff families
• Assist staff in work restriction/quarantine
  situations
• Provide support for urgent needs of staff
  families

12
Systems-Based Process Enhances Hospital Planning

• Provides activity overview, integrated across
  departments
• Adapts to either administrative or departmental
  planning levels
• Highlights interactions and dependencies among
  activities
• Systematizes, supports, and augments existing
  institutional planning processes
• Aids in developing plans that are integrated and
  coordinated among hospitals and county, state,
  and federal resources