Suspended Reality The New Vista of Compliance – Disaster Planning, Preparation, Response and Recovery Education through Immersion Simulation

Suspended Reality The New Vista of Compliance – How to Save $13920/bed per yr, Increase Surge Capacity 400%, Decrease Emergency Room Wait 50%, and Meet the September 30, 2008 Deadline

A Game of Numbers What is the United States Population? 300 million people How Many Hospital Beds in the United States? 955,768 (AHA, 2005) How Many Hospital Beds are Staffed? 726,384 (AHA, 2005) What Percent are Occupied During Flu Season? 96% -or- 917,537 (AHA, 2005) What Surge Capacity is Required by HHS & HRSA? 20% -or- 191,154 (HHS) 500 beds per million -or- 150,000 (HRSA) Only have 38,231 beds!!!

What is the United States Population?

300 million people

How Many Hospital Beds in the United States?

955,768 (AHA, 2005)

How Many Hospital Beds are Staffed?

726,384 (AHA, 2005)

What Percent are Occupied During Flu Season?

96% -or- 917,537 (AHA, 2005)

What Surge Capacity is Required by HHS & HRSA?

20% -or- 191,154 (HHS)

500 beds per million -or- 150,000 (HRSA)

Only have 38,231 beds!!!

A Game of Numbers What is the United States Population? 300 million people How Many Ventilators in the United States? 105,000 (M. Olsterholm – NEJM, 2004) How Many are Out of Service for Cleaning or Repair? 18% -or- 18,900 (M. Olsterholm – NEJM, 2004) How Many are for Chronic Ventilator Dependent Patients? 67% -or- 70,035 (M. Olsterholm – NEJM, 2004) How Many Ventilators are Available for Acute Use? 15% -or- 16,365 (M. Olsterholm – NEJM, 2004) Only have 38,231 beds!!!

What is the United States Population?

300 million people

How Many Ventilators in the United States?

105,000 (M. Olsterholm – NEJM, 2004)

How Many are Out of Service for Cleaning or Repair?

18% -or- 18,900 (M. Olsterholm – NEJM, 2004)

How Many are for Chronic Ventilator Dependent Patients?

67% -or- 70,035 (M. Olsterholm – NEJM, 2004)

How Many Ventilators are Available for Acute Use?

15% -or- 16,365 (M. Olsterholm – NEJM, 2004)

Only have 38,231 beds!!!

A Game of Numbers What is the United States Population? 300 million people How Many in the United States Will Become Sick in a Flu Pandemic? 1 in 3 -or- 100 million (Historical Records 1918) How Many of the Sick Will Require Assisted Care? Half -or- 50 million (Historical Records 1918) How Many of Those Requiring Care Will Require Hospital Care? Half -or- 25 million (Historical Records 1918) How Many of Those Requiring Hospitalization will need Intubation? Half -or- 12.5 million (Historical Records 1918) How Many of Those Requiring Intubation will Die? Half -or- 6.25 million (Historical Records 1918) Only have 38,231 beds and 16,365 ventilators!!!

What is the United States Population?

300 million people

How Many in the United States Will Become Sick in a Flu Pandemic?

1 in 3 -or- 100 million (Historical Records 1918)

How Many of the Sick Will Require Assisted Care?

Half -or- 50 million (Historical Records 1918)

How Many of Those Requiring Care Will Require Hospital Care?

Half -or- 25 million (Historical Records 1918)

How Many of Those Requiring Hospitalization will need Intubation?

Half -or- 12.5 million (Historical Records 1918)

How Many of Those Requiring Intubation will Die?

Half -or- 6.25 million (Historical Records 1918)

Only have 38,231 beds and 16,365 ventilators!!!

What is the United States Population? 300 million people and 100 million with Pan-Flu Where did the CDC numbers come from? 1 in 3 -or- 33% get sick How Many of the Sick Will Require Assisted Care? Half -or- 16% How Many of Those Requiring Care Will Require Hospital Care? Half -or- 8% How Many of Those Requiring Hospitalization will need Intubation? Half -or- 4% How Many of Those Requiring Intubation will Die? Half -or- 2% Only have 38,231 beds and 16,365 ventilators!!! A Game of Numbers (CDC assumes these are NOT hospitalized) (CDC says 8% of the ill, but it actually is out of 300 million) (CDC says 2% die, but again this is out of 300 million) (CDC says 4% of the hospitalized, but it is out of 300 million)

What is the United States Population?

300 million people and 100 million with Pan-Flu

Where did the CDC numbers come from?

1 in 3 -or- 33% get sick

How Many of the Sick Will Require Assisted Care?

Half -or- 16%

How Many of Those Requiring Care Will Require Hospital Care?

Half -or- 8%

How Many of Those Requiring Hospitalization will need Intubation?

Half -or- 4%

How Many of Those Requiring Intubation will Die?

Half -or- 2%

Only have 38,231 beds and 16,365 ventilators!!!

The Flood of Humanity 7 Patients by EMS 28 Self Transport 140 Psychological Casualties 175 Patients in the First Hour

The Flood of Humanity 175 Patients in the First Hour But Wait There’s More!

The Flood of Humanity 175 Patients in the First Hour 350 Family, Friends & Bystanders 525 Searching for the Missing

The Flood of Humanity Total Surge: 1050 From Only 7 EMS Patients

Building for Resilience Emergency Preparedness

Emergency Preparedness

Managing the Masses Total Surge of 1050 350 Family, Friends & Bystanders 525 Searching for the Missing 875 Sent to Family Center 175 Patients to Decon, Triage & Treat

Managing the Masses 7 Patients by EMS 28 Self Transport 140 Psychological Casualties 175 Patients to Decon, Triage & Treat 35 Patients to Decon, Triage & Treat 7 Patients to Decon, Triage & Treat This is the Power of Integrated Triage

Four Lessons in Life  Lessons Occurred  Lessons Observed  Lessons Learned  Lessons Applied

 Lessons Occurred

 Lessons Observed

 Lessons Learned

 Lessons Applied

Increasing Educational ROI Immersion Simulation Read and Hear (20% Retained) Books, Audios, Lectures See and Hear (50% Retained) – Video See (30% Retained) – Still Photos Say & Write (70% Retained) Demonstration, Workshop Table-Top (80% Retained) 90% Retained

Immersion Simulation vs .

Steps to Preparedness Vulnerability Analysis All Hazards Review Didactic Education All Hazards Preparedness All Hazards Planning Immersion Simulation Institute of Medicine Standard ( To Err is Human ) All Hazards Exercises (Disaster Drills) Continuous Plan Review and Revision

Vulnerability Analysis

All Hazards Review

Didactic Education

All Hazards Preparedness

All Hazards Planning

Immersion Simulation

Institute of Medicine Standard ( To Err is Human )

All Hazards Exercises (Disaster Drills)

Continuous Plan Review and Revision

Currently: “All Hazards” = “All Disasters” What if we redefine: “All Hazards” = All Disasters Patient Safety Visitor Safety Employee Safety Facility Safety A New Definition of “All Hazards” “ All Hazards”

Currently: “All Hazards” = “All Disasters”

What if we redefine: “All Hazards” =

All Disasters

Patient Safety

Visitor Safety

Employee Safety

Facility Safety

Steps to Preparedness Vulnerability Analysis All Hazards Review Didactic Education All Hazards Preparedness All Hazards Planning Immersion Simulation Institute of Medicine Standard ( To Err is Human ) All Hazards Exercises (Response Rehearsals) Continuous Plan Review and Revision

Vulnerability Analysis

All Hazards Review

Didactic Education

All Hazards Preparedness

All Hazards Planning

Immersion Simulation

Institute of Medicine Standard ( To Err is Human )

All Hazards Exercises (Response Rehearsals)

Continuous Plan Review and Revision

NRP – NIMS – CMS – JCAHO National Response Plan (December 2004) All Hazards / All Agencies Defines the Function and Responsibility of Each Organizational Element under the Plan Planning (Thinkers) Logistics (Getters) Finance (Payers) Operations (Doers)

National Response Plan (December 2004)

All Hazards / All Agencies

Defines the Function and Responsibility of Each Organizational Element under the Plan

Planning (Thinkers)

Logistics (Getters)

Finance (Payers)

Operations (Doers)

NRP – NIMS – CMS – JCAHO National Incident Management System Framework for Incident Command Single Common Command Structure Common Organizational Structure Outline for Disaster Response Planning Mandates Classification of Resources Implemented and Updated by the NIMS Integration Center (NIMS-IC)

National Incident Management System

Framework for Incident Command

Single Common Command Structure

Common Organizational Structure

Outline for Disaster Response Planning

Mandates Classification of Resources

Implemented and Updated by the NIMS Integration Center (NIMS-IC)

NRP – NIMS – CMS – JCAHO NIMS Implementation for Hospitals and Healthcare Facilities Element 1: Adoption of NIMS Element 2: Incident Command System (ICS) Element 3: Multiagency Coordination System Element 4: Public Information System Element 5: NIMS Implementation Tracking Element 6: Preparedness Funding

NIMS Implementation for Hospitals and Healthcare Facilities

Element 1: Adoption of NIMS

Element 2: Incident Command System (ICS)

Element 3: Multiagency Coordination System

Element 4: Public Information System

Element 5: NIMS Implementation Tracking

Element 6: Preparedness Funding

NRP – NIMS – CMS – JCAHO NIMS Implementation for Hospitals and Healthcare Facilities Element 7: Revise and Update Plans Element 8: Mutual Aid Agreements Element 9: ICS 700 NIMS Training Element 10: ICS 800.A NRP Training Element 11: ICS 100 & 200 Training Element 12: Training and Exercises

NIMS Implementation for Hospitals and Healthcare Facilities

Element 7: Revise and Update Plans

Element 8: Mutual Aid Agreements

Element 9: ICS 700 NIMS Training

Element 10: ICS 800.A NRP Training

Element 11: ICS 100 & 200 Training

Element 12: Training and Exercises

NRP – NIMS – CMS – JCAHO NIMS Implementation for Hospitals and Healthcare Facilities Element 13: All-Hazards Exercise Program Element 14: Corrective Actions Element 15: Response Inventory Element 16: Resource Acquisition Element 17: Standard & Consistent Terms

NIMS Implementation for Hospitals and Healthcare Facilities

Element 13: All-Hazards Exercise Program

Element 14: Corrective Actions

Element 15: Response Inventory

Element 16: Resource Acquisition

Element 17: Standard & Consistent Terms

Preparedness Balance Sheet Sticks NIMS-IC for Hospitals Joint Commission Medicare/Medicaid CMS Attestations Willful Blindness Qui Tam Sarbanes-Oxley Carrots Public Relations Community Relations Employee Relations Customer Service Preferential Billing Rapid Recovery

Sticks

NIMS-IC for Hospitals

Joint Commission

Medicare/Medicaid

CMS Attestations

Willful Blindness

Qui Tam

Sarbanes-Oxley

Carrots

Public Relations

Community Relations

Employee Relations

Customer Service

Preferential Billing

Rapid Recovery

Preparedness Balance Sheet Process Enhancement Process Analysis Business Processes Healthcare Processes Income Streams Daily Needs/Resources Inventory Benchmark Triggered Targeted Process Enhancement Event Response Vulnerability Analysis Hazard Based Kaiser Model Income Insensitive Centered on Recognized Events Event Triggered Untargeted Response and Expenditure

Process Enhancement

Process Analysis

Business Processes

Healthcare Processes

Income Streams

Daily Needs/Resources Inventory

Benchmark Triggered

Targeted Process Enhancement

Event Response

Vulnerability Analysis

Hazard Based

Kaiser Model

Income Insensitive

Centered on Recognized Events

Event Triggered

Untargeted Response and Expenditure

Preparedness Balance Sheet Event Response Model Costs Equipment Staff Training Salaries for Training Resource Stockpiles Externally Validated Drills and Exercises Extra Personnel Dollars and Sense $1000/Licensed Bed $2800/Licensed Bed/yr. $1280/Licensed Bed/yr. $1000/Licensed Bed $500/Licensed Bed/drill (2 per year) $960/Licensed Bed/day Total Cost = $9000/bed/yr

Costs

Equipment

Staff Training

Salaries for Training

Resource Stockpiles

Externally Validated Drills and Exercises

Extra Personnel

Dollars and Sense

$1000/Licensed Bed

$2800/Licensed Bed/yr.

$1280/Licensed Bed/yr.

$1000/Licensed Bed

$500/Licensed Bed/drill (2 per year)

$960/Licensed Bed/day

Total Cost = $9000/bed/yr

Preparedness Balance Sheet Event Response Model Dollars and Sense $0.00 $0.00 Priceless Total Revenue = $0.00 Business Benefits Joint Commission NIMS Compliance Legal Protection Qui Tam Sarbanes Oxley

Dollars and Sense

$0.00

$0.00

Priceless

Total Revenue = $0.00

Business Benefits

Joint Commission

NIMS Compliance

Legal Protection

Qui Tam

Sarbanes Oxley

Preparedness Balance Sheet Event Response Model Costs Equipment Staff Training Salaries for Training Resource Stockpiles Externally Validated Drills and Exercises Response Personnel NET LOSS = $9000/bed/yr Business Benefits Joint Commission NIMS Compliance Legal Protection Qui Tam Sarbanes Oxley

Costs

Equipment

Staff Training

Salaries for Training

Resource Stockpiles

Externally Validated Drills and Exercises

Response Personnel

NET LOSS = $9000/bed/yr

Business Benefits

Joint Commission

NIMS Compliance

Legal Protection

Qui Tam

Sarbanes Oxley

Preparedness Balance Sheet Process Enhancement Model Costs Equipment Staff Training Salaries for Training Resource Stockpiles Externally Validated Drills and Exercises Extra Personnel Dollars and Sense $1000/Licensed Bed $2800/Licensed Bed/yr. $1280/Licensed Bed/yr. $1000/Licensed Bed $500/Licensed Bed/drill (1 per year) <$480/Licensed Bed/day Total Cost = $11380/bed/yr

Costs

Equipment

Staff Training

Salaries for Training

Resource Stockpiles

Externally Validated Drills and Exercises

Extra Personnel

Dollars and Sense

$1000/Licensed Bed

$2800/Licensed Bed/yr.

$1280/Licensed Bed/yr.

$1000/Licensed Bed

$500/Licensed Bed/drill (1 per year)

<$480/Licensed Bed/day

Total Cost = $11380/bed/yr

Preparedness Balance Sheet Process Enhancement Model Business Benefits Joint Commission NIMS Compliance Legal Protection Qui Tam Sarbanes Oxley Improved Customer Satisfaction Fewer AMA/LWOT Increased Admits Dollars and Sense $0.00 $0.00 Priceless Priceless $300/Licensed Bed/yr $16000/Licensed Bed/yr Total Revenue = $16300/Bed/yr

Business Benefits

Joint Commission

NIMS Compliance

Legal Protection

Qui Tam

Sarbanes Oxley

Improved Customer Satisfaction

Fewer AMA/LWOT

Increased Admits

Dollars and Sense

$0.00

$0.00

Priceless

Priceless

$300/Licensed Bed/yr

$16000/Licensed Bed/yr

Total Revenue = $16300/Bed/yr

Preparedness Balance Sheet Process Enhancement Model Costs Equipment Staff Training Salaries for Training Resource Stockpiles Externally Validated Drills and Exercises Extra Personnel Business Benefits Joint Commission NIMS Compliance Legal Protection Qui Tam Sarbanes Oxley Improved Customer Satisfaction Fewer AMA/LWOT Increased Admits Targeted Response reduces cost of response NET PROFIT = $4920/Bed/yr

Costs

Equipment

Staff Training

Salaries for Training

Resource Stockpiles

Externally Validated Drills and Exercises

Extra Personnel

Business Benefits

Joint Commission

NIMS Compliance

Legal Protection

Qui Tam

Sarbanes Oxley

Improved Customer Satisfaction

Fewer AMA/LWOT

Increased Admits

Targeted Response reduces cost of response

NET PROFIT = $4920/Bed/yr

Preparedness Balance Sheet Process Enhancement Process Analysis Business Processes Healthcare Processes Income Streams Daily Needs/Resources Inventory Benchmark Triggered Targeted Process Enhancement Net Profit: $4920/Bed/yr Event Response Vulnerability Analysis Hazard Based Kaiser Model Income Insensitive Centered on Recognized Events Event Triggered Untargeted Response and Expenditure Net Loss: $9000/Bed/yr

Process Enhancement

Process Analysis

Business Processes

Healthcare Processes

Income Streams

Daily Needs/Resources Inventory

Benchmark Triggered

Targeted Process Enhancement

Net Profit: $4920/Bed/yr

Event Response

Vulnerability Analysis

Hazard Based

Kaiser Model

Income Insensitive

Centered on Recognized Events

Event Triggered

Untargeted Response and Expenditure

Net Loss: $9000/Bed/yr

From Preparedness to Profitability Given that the investment is required NIMS Compliance Joint Commission Medicare/Medicaid CMS Attestation Qui Tam Sarbanes-Oxley Given that the investment is the same Process Enhancement Model Event Response Model

Given that the investment is required

NIMS Compliance

Joint Commission

Medicare/Medicaid

CMS Attestation

Qui Tam

Sarbanes-Oxley

Given that the investment is the same

Process Enhancement Model

Event Response Model

From Preparedness to Profitability Process Enhancement (ROI) Higher Retention of New Knowledge Better Implementation of New Skills Greater Surge Capacity Shorter Wait Times Improved Customer Satisfaction Fewer AMA’s/LWOT’s More Admissions Shorter Disaster Response Phase Quicker Return to Full Operations Gross Savings of $13920/Licensed Beds/yr

Process Enhancement (ROI)

Higher Retention of New Knowledge

Better Implementation of New Skills

Greater Surge Capacity

Shorter Wait Times

Improved Customer Satisfaction

Fewer AMA’s/LWOT’s

More Admissions

Shorter Disaster Response Phase

Quicker Return to Full Operations

Gross Savings of $13920/Licensed Beds/yr