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Creating Hospital Surge Capacity:Hospital Functions and Reallocation of
Resources
THIRD NATIONAL EMERGENCY MANAGEMENT SUMMIT The Leading Forum on Disaster, Epidemic and Terrorism Planning,
Response and Recovery for Healthcare Organizations
Renaissance Washington DC Hotel Washington, DC
March 4 - 6, 2009
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Presentation ObjectivesPresentation Objectives
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Identify hospital functions critical to the maintenance and creation of surge capacityIdentify a potential method for closing gaps in medical surge demandsIdentify a scalable method able to meet the demands of differenttypes of incidents, adaptable to a variety of hospital sizes andconfigurations and consistent with CDC, ASPR, OSHA, CMS and The Joint Commission standards and guidelines
Identify hospital functions critical to the maintenance and creation of surge capacityIdentify a potential method for closing gaps in medical surge demandsIdentify a scalable method able to meet the demands of differenttypes of incidents, adaptable to a variety of hospital sizes andconfigurations and consistent with CDC, ASPR, OSHA, CMS and The Joint Commission standards and guidelines
Presentation Objectives
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IntroductionIntroduction
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Efforts to contain the economic burden of healthcare in the United States have resulted in improved efficiency in hospital operationsIn part, these efficiencies have been obtained by reducing bed capacity, running near maximum hospital capacity and adjusting resources including staffing ratiosHealthcare 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 warningThe 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
Efforts to contain the economic burden of healthcare in the United States have resulted in improved efficiency in hospital operationsIn part, these efficiencies have been obtained by reducing bed capacity, running near maximum hospital capacity and adjusting resources including staffing ratiosHealthcare 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 warningThe 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
Introduction
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MandateMandate
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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
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
Mandate
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BackgroundBackground
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Large scale disasters such as hurricane Katrina have drawn attention to the need for medical surge capacityIronically, it is this surge capacity that was eliminated in order to maximize efficiencyWithin 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
Large scale disasters such as hurricane Katrina have drawn attention to the need for medical surge capacityIronically, it is this surge capacity that was eliminated in order to maximize efficiencyWithin 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
Background
Photo credit: LSU, Jon Best
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ChallengesChallenges
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Surge needs associated with a pandemic are among the most challenging given that surge capacity would likely be depletedNo 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
Surge needs associated with a pandemic are among the most challenging given that surge capacity would likely be depletedNo 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
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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 incidentCommonly, hospital disaster plans rely on external sources to maintain surge capabilities and create additional capacityExternal mechanisms include alternate care sites, patient transfers, volunteerism and special disaster medical assistance teams
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 incidentCommonly, hospital disaster plans rely on external sources to maintain surge capabilities and create additional capacityExternal mechanisms include alternate care sites, patient transfers, volunteerism and special disaster medical assistance teams
Challenges
Emergency Credentialing Program
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AssumptionsAssumptions
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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 hospitalDuring a large-scale surge incident certain hospital services will be cancelledDepartments within the hospital may be combined to perform functions required by the particular surge incident that extends over multiple operational periodsStaff may be reassigned and function competently within their field of expertise with applicable just-in-time training
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 hospitalDuring a large-scale surge incident certain hospital services will be cancelledDepartments within the hospital may be combined to perform functions required by the particular surge incident that extends over multiple operational periodsStaff may be reassigned and function competently within their field of expertise with applicable just-in-time training
Assumptions
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External assistance is unlikely to be available to hospitals in national catastrophes such as a pandemicEmployee 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 normPrudent hospital planning must include internal mechanisms for increasing capacity and maintaining capability
External assistance is unlikely to be available to hospitals in national catastrophes such as a pandemicEmployee 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 normPrudent hospital planning must include internal mechanisms for increasing capacity and maintaining capability
Assumptions
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ScopeScope
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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 capacityWithin 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
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 capacityWithin 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
Scope
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HESF CategoriesHESF Categories
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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
The Hospital Emergency Support Functions Project identified the following as essential functions of hospitals:– Patient Care– Staff– Facilities– Communications– Safety/Security– Business Continuity
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Clinical Services Clinical Support ServicesEmergency Family and Staff SupportNutrition ServicesMortuary ServicesMaintenance, Engineering and EnergyResource Support and Materials ManagementCommunications and Information TechnologyPublic InformationTransportationSafetySecurity Information and PlanningFinanceHuman Resources
Clinical Services Clinical Support ServicesEmergency Family and Staff SupportNutrition ServicesMortuary ServicesMaintenance, Engineering and EnergyResource Support and Materials ManagementCommunications and Information TechnologyPublic InformationTransportationSafetySecurity Information and PlanningFinanceHuman Resources
HESF CategoriesTo fulfill the essential functions of the hospital, 15 “Hospital Emergency Support Functions” (HESFs) were identified as follows:
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Hospital FunctionsHospital Functions
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Hospital Essential Support Functions
Function HESF Number Primary Support
Patient Care
#1 Clinical Services
- Emergency Services - Critical Care - Med/Surg - Labor and Delivery - Maternity - Pediatrics - Psychiatry
- Ambulatory Care - Cardiology - Home Care - Obstetrics and Gynecology - Rehabilitation Services
#2 Clinical
Support Services
- Diagnostic Imaging - Epidemiology - Intravenous Therapy - Laboratory - Pharmacy - Respiratory Therapy
- Cath Lab - Echocardiography - EEG - Endoscopy - Interventional Radiology - Peripheral Vascular Lab - Physical Medicine - Radiation Therapy - Sleep Lab - Wound Care
#3 Emergency Family and Staff Support
- Care Management - Children's Psychiatric Services - Day Care - Pastoral Care - Psychiatry Services - Social Services
- Elder Care Program - Employee Wellness - Outreach Program - Support Services - Wellness Program
#4 Nutrition
- Cafeteria - Food and Nutrition - Kitchen
- Coffee Shop
#5 Mortuary
- Pathology None
Hospital Functions
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Facilities
#6 Maintenance, Engineering,
and Energy
- Biomedical Engineering - Clinical Engineering - Environmental Services - Laundry/Linen Services - Maintenance - Plant Engineering
None
#7 Resource Support and Materials Management
- Central Processing - Finance Department - Human Resources - Material Management - Purchasing - Receiving - Shipping - Stockroom
- Development Office - Foundation - Supply Chain Management
Communi- cations
#8 Communication and
Information Technology
- Clinical Applications - Help Desk - Information Systems - Interpreter Services - Telecommunications
- Call Center - Compliance Hot Line - Copy Center - Library Services - Marketing and
Communication - Marketing and System
Development - Multimedia Services
#9 Public Information
- Employee Relations - Mailroom - Patient Relations - Public Relations
- Information Services - Lobby/Main Desk - Physician Relations
Hospital Functions
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Safety/ Security
#10 Transportation
- Auxillary - Motor Services - Parking Operations - Patient Escort and Distribution
- Garage
#11 Safety
- Risk Management - Occupationsl Medicine - Safety Officer
None
#12 Security
- Protective Services - Security
None
Business Continuity
#13 Information and Planning
- Administration - Budget and Planning - Facilities Planning and Management - Legal and Risk Services
- Community and Gov. Relations - Corporate Compliance - Decision Support - Financial Planning - Plan and Business Development - Strategic Develop. and Marketing
#14Finance
- Accounting - Accounts Payable - Budget and Reimbursement - Credit Union - Finance - Payroll - Worker's Compensation
- Cashiers - Corporate Finance - Fiscal Servives - Grants and Contracts - Patient Financial Services - Reimbursement
Hospital Functions
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Staff
#3 Emergency Staff and Family
Support
- Employee Assistance Program - Employee Wellness
#15 Human Resources
- Float Pool - Hospitalist Service - House Staff Office - Human Resources - Medical Staff Office - Nursing Office - Volunteers
- Student Services
Hospital Functions
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Compatibility ModelCompatibility Model
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HOSPITAL EMERGENCY SUPPORT FUNCTIONS (HESF)
HESF Number Function Name Description Primary
DepartmentsSupporting
Departments
HICS Section Chief(s)
HICS Branch
Director(s)
HICS Unit Leader(s)
HESF #1 Clinical Services
Direct patient care: emergency medicine, critical
care, emergency anesthesia/surgery;
ambulatory and specialty care as resources allow
Patient Care Services
Transportation, Social Services, Pastoral Care,
Volunteer Services
Operations Section Chief
Medical Care Branch Director
Inpatient Unit Leader, Outpatient
Unit Leader, Casualty Care Unit
Leader
HESF #2 Clinical Support Services
Laboratory, Radiology, Pharmacy, Respiratory
Care, etc.
Laboratory, Radiology, Pharmacy
Radiation Therapy, Pathology, Medical Education, Anesthesiology, Volunteer Services
Operations Section Chief
Medical Care Branch Director
Clinical Support Services Unit
Leader
HESF #3Emergency Family
and Staff Support
Social work; Pastoral care; Critical Incident Stress
Management; Interpreter Services; day care, elder
care, mental health, temporary sheltering;
distribution of essentail supplies
Pastoral Care, Social Services
Volunteer Services, Human Resources
Logistics Section Chief
Support Branch Director
Familcy Care Unit Leader, Employee Health & WB Unit
Leader,
Compatibility Model
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HOSPITAL EMERGENCY SUPPORT FUNCTIONS (HESF)
HESF Number Function Name Description Primary
DepartmentsSupporting
Departments
HICS Section Chief(s)
HICS Branch
Director(s)
HICS Unit Leader(s)
HESF #4 Nutrition Services
Coordinate with materials management to secure bulk food, water and ice; mass
feeding
Food and Nutrition Services
Environmental Services, Volunteer
Services
Logistics Section Chief,
Operations Section Chief
Service Branch Director (Logs), Infrastructure
Branch Director (Ops)
Staff Food & Water Unit Leader (Logs), Food Services Unit
Leader (Ops)
HESF #5 Mortuary Services
Expansion of facilities/capacity;
postmortem examination & identification; tracking and
liaison to families
Pathology
Environmental Services, Hospital volunteer Services, Pastoral Care, Social Services
Operations Section Chief
Medical Care Branch Director
Casualty Care Unit Leader
HESF #6
Maintenance, Engineering
& Energy
Support or restore essential plant operations, back-up
power and water
Plant Engineering, Hospital Maintenance, Facilities Management, Environmental Services
Safety and Security Operations Section Chief
Infrastructure Branch Director
Power/Lighting Unit Leader,
Water/Sewer Unit Leader, HVAC Unit
Leader, Building/Grounds
Damage Unit Leader, Medical
Gasses Unit Leader, Bedical
Devices Unit Leader,
Environmental Svs Unit Leader
HESF #7
Resource Support & Materials Management
Expansion of just-in time inventory; purchasing,
leasing, management of MOUs/MOAs; Coordination
of donations; logistical resource support and
liaisons
Materials Management,
Purchasing
Development Office, Volunteer Services
Logistics Section Chief,
Finance Section Chief
Support Branch Director (Logs)
Supply Unit Leader (Logs), Cost Unit Leader (Finance), Procurement Unit Leader (Finance)
Compatibility Model
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HOSPITAL EMERGENCY SUPPORT FUNCTIONS (HESF)
HESF Number Function Name Description Primary
DepartmentsSupporting
Departments
HICS Section Chief(s)
HICS Branch
Director(s)
HICS Unit Leader(s)
HESF #8Communications &
Information Technology
Support or restore information services,
telemedicine, telephonics, paging to support internal
functions and external connectivity; emergency
notification of staff
Information Technology,
Telecommunicat ions
Volunteer Services, Public Relations,
Safety and Security. Medical Records
Logistics Section Chief
Support Branch Director
IT/IS Unit Leader
HESF #9 Public Information Risk communications to staff and public;
Public Relations
OEP, HR, Information and
Planning, Occupational
Health, Safety and Security
Command Staff
Public Information Officer N/A
HESF #10 Transportation
Logistical support for internal and external transport of
patients; delivery of energy and supplies; securing of
transport routes in conjunction with security;
facility evacuation
Transportation Courier, Materials management
Safety and Security Logistics Section Chief
Support Branch Director
Tranportation Unit Leader
HESF #11 Safety
Coordinates comprehensive health and safety program to include hazardous material and waster management. Ensure compliance with local, state and federal
agencies. Ensures staff safety screening to include
PPE, fit testing, etc.
Occupational Medicine
Patient Care Services,
Pharmacy, Facilities Management
Command Staff Safety Officer N/A
Compatibility Model
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HOSPITAL EMERGENCY SUPPORT FUNCTIONS (HESF)
HESF Number Function Name Description Primary
DepartmentsSupporting
Departments
HICS Section Chief(s)
HICS Branch
Director(s)
HICS Unit Leader(s)
HESF #12 Security
Provides security resources to support logistical, medical, transportation and security services. Coordinates the
mobilization of law enforcement.
Security
Plant Engineering, Maintenance,
Facilities Management,
Volunteer Services
Operations Section Chief
Security Branch Director
Access Control Unit Leader, Crowd
Control Unit Leader, Traffic
Control Unit Leader, Search
Unit Leader, Law Enforcement Interface Unit
Leader
HESF #13 Information and Planning
Situational awareness; surge enhancements; mobilization,
scaling of response, demobilization; resource
capabilities; coordination with state emergency response
team
Safety and security,
Admitting Office, Incident
Command/EM Manager
OEP Planning Section Chief N/A
Resource Unit Leader,
Documentation Unit Leader, Situation Unit
Leader
HESF #14 Finance
Approval and tracking of expenditures; filing of claims
(insurers, government disaster reimbursement, etc.); emergency payroll
policies
Finance Human Resources, Risk management
Finance/ Adminstration Section Chief
N/ATime, Unit Leader, Compensation/Clai mes Unit Leader
HESF #15 Human Resources
Coordination of alternate/reassigned staff and volunteers; absentee
policies; furloughs; coordination with payroll;
coordination of cross- training; credentials
verification
Human Resources
Finance, Medical Records,
Occupational Health, Housing Office, Facilities
Management
Logistics Section Chief
Support Branch Director
Labor Pool & Credentialing Unit
Leader
Compatibility Model
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An Emergency Response:An Emergency Response: Operational DiagramOperational Diagram
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Operational Diagram
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Policies for ConsiderationPolicies for Consideration
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Who will authorize the implementation of the Hospital Emergency Support Functions (HESF) in response operationsWho coordinates the assessment of staffing needs across all patient care areasIn conjunction with ICS/HICS who authorizes the use of support department’s to augment clinical and non-clinical operationsRole of Labor Pool Unit Leader
Who will authorize the implementation of the Hospital Emergency Support Functions (HESF) in response operationsWho coordinates the assessment of staffing needs across all patient care areasIn conjunction with ICS/HICS who authorizes the use of support department’s to augment clinical and non-clinical operationsRole of Labor Pool Unit Leader
Policies for Consideration
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Next StepsNext Steps
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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
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
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Next Steps
Develop and test process by which identification and reassignment tracking will be accomplishedPrepare user’s manual – “Using the HRDB in an Emergency Response”Provide identified members of HICS/ICS with training in the use of the databaseDesign and develop an exercise testing the utility of the database to identify staff for transfer during a medical surge event
Develop and test process by which identification and reassignment tracking will be accomplishedPrepare user’s manual – “Using the HRDB in an Emergency Response”Provide identified members of HICS/ICS with training in the use of the databaseDesign and develop an exercise testing the utility of the database to identify staff for transfer during a medical surge event
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Questions and CommentsQuestions and Comments
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Contact Information
James L. Paturas, CEM, EMTP, CBCP, FACCPDeputy Director(203) 688-3224
Yale New Haven Center for Emergency Preparedness and Disaster Response
1 Church Street, 5th Floor New Haven, CT 06510 www.yalenewhavenhealth.org/emergency
James L. Paturas, CEM, EMTP, CBCP, FACCPDeputy Director(203) 688-3224
Yale New Haven Center for Emergency Preparedness and Disaster Response
1 Church Street, 5th Floor New Haven, CT 06510 www.yalenewhavenhealth.org/emergency