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Pandemic Influenza : Hospital and Clinic Planning by Dan O'Laughlin

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Dan O'Laughlin's presentation at the Sept. 10, 2009 H1N1: Lessons from the Southern Hemisphere and Minnesota's Preparedness at the University of Minnesota.

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Pandemic Influenza : Hospital and Clinic Planning by Dan O'Laughlin

  1. 1. Pandemic Influenza Hospital and Clinic Planning Daniel T. O’Laughlin, MD, FACEP Medical Director of Emergency Preparedness Abbott Northwestern Hospital Assistant Professor of Emergency Medicine University of Minnesota September 10, 2009
  2. 2. Successful Pandemic Preparedness Defined ? <ul><li>“ Every hospital, in collaboration with other hospitals and with public health agencies, will be able to provide appropriate care to flu victims requiring hospitalization while maintaining other essential medical services in the community, both during and after a pandemic.” </li></ul><ul><li>Eric Toner and Richard Waldhorn. Perspective: </li></ul><ul><li>What Hospitals Should Do to Prepare for an </li></ul><ul><li>Influenza Pandemic. Biosecurity and Bioterrorism. </li></ul><ul><li>Volume 4, Number 4, 2006 </li></ul>
  3. 3. Economic Realities <ul><li>“ Just In Time” economy affects healthcare as well </li></ul><ul><li>Hospitals, if profitable, only have a thin profit margin (avg 1.9%) </li></ul><ul><ul><li>30% of US hospitals are currently losing money </li></ul></ul><ul><li>Average US hospital has 41 days of cash on hand </li></ul><ul><li>A hospital’s ability to offset typical lost revenue from illness related hospitalizations with elective procedures will be greatly reduced or eliminated altogether </li></ul>
  4. 4. Hospital Planning Priority Considerations <ul><li>Regional collaborative planning that is realistic </li></ul><ul><li>Infection Control </li></ul><ul><ul><li>Limit nosocomial spread </li></ul></ul><ul><ul><ul><li>Protects HCW, other inpatients and prevents hospitals from amplifying the disease spread </li></ul></ul></ul>
  5. 6. Hospital Planning Priority Considerations <ul><li>Hospital workforce management </li></ul><ul><li>Allocation of scare resources </li></ul>
  6. 7. Potential Planning Roadblocks <ul><li>Healthcare surge capacity is low </li></ul><ul><li>Personal preparedness is poor </li></ul><ul><li>Hospital administration buy-in is variable </li></ul><ul><li>Financial support is poor </li></ul><ul><li>Staff absenteeism </li></ul><ul><li>Union concerns </li></ul><ul><li>Insufficient PPE/Meds/Vaccine for HCWs </li></ul><ul><li>Workforce licensing restrictions & rapid credentialing </li></ul><ul><li>Specialization / Compartmentalization of healthcare </li></ul>
  7. 8. Minnesota Hospitals <ul><li>134 Acute Care Hospitals in MN </li></ul><ul><ul><li>Over 2/3 are private, nonprofit organizations </li></ul></ul><ul><li>Urban Location – 53 </li></ul><ul><li>Rural Location – 81 </li></ul><ul><ul><li>79 are designated Critical Access Hospitals </li></ul></ul><ul><li>29 % of MN acute care hospitals operate either in the red or with a < 5% operating margin </li></ul><ul><ul><li>(based on 2007 HCCIS data) </li></ul></ul>
  8. 10. MSP Metro Acute Care Hospitals MNTrac Snapshot from 09-09-09 Bed Type Available Total Percent Staffed and Available Adult ICU 52 513 10.14% Burn Care 1 35 2.86% Med-Surg 172 2398 7.17% Non CC monitored 61 888 6.87% Peds ICU 10 95 10.53% Peds Medical 49 429 11.42% Behavioral Health 14 559 2.50% NICU 20 193 10.36%
  9. 11. Facility-based Surge 10-20% operating bed capacity could be mobilized <ul><li>Get ‘em up and get ‘em out (ED, clinics) </li></ul><ul><li>Discharges and transfers (eg: nursing home) </li></ul><ul><ul><li>Discharge holding area </li></ul></ul><ul><li>Board patients in halls </li></ul><ul><li>Cancel elective procedures </li></ul><ul><li>Convert procedure/PACU areas to patient care </li></ul><ul><li>Accommodate vents on floor (or BVM or austere O2 flow powered ventilators) </li></ul><ul><li>Supply and staffing issues (72h ahead) </li></ul>
  10. 12. Surge Capacity C S T <ul><li>The 4 C’s </li></ul><ul><ul><li>Command </li></ul></ul><ul><ul><li>Control </li></ul></ul><ul><ul><li>Communications </li></ul></ul><ul><ul><li>Coordination </li></ul></ul><ul><li>* Surge capacity CANNOT occur if you don’t ‘get all C’s’ </li></ul><ul><li>The 4 S’s </li></ul><ul><ul><li>Space </li></ul></ul><ul><ul><li>Staff </li></ul></ul><ul><ul><li>Stuff </li></ul></ul><ul><ul><li>Special </li></ul></ul><ul><li>The 3 T’s </li></ul><ul><ul><li>Triage </li></ul></ul><ul><ul><li>Treat </li></ul></ul><ul><ul><li>Transport </li></ul></ul>
  11. 13. Staff <ul><li>ALL job categories will have significant absenteeism </li></ul><ul><ul><li>From NYC Healthcare Worker Survey </li></ul></ul><ul><ul><ul><li>>50% had childcare issues </li></ul></ul></ul><ul><ul><ul><li>~27% had eldercare issues </li></ul></ul></ul><ul><ul><ul><li>~30% had a spouse expected to respond </li></ul></ul></ul><ul><li>Creative use of volunteers may be needed </li></ul><ul><li>Rapid credentialing process for volunteers </li></ul>
  12. 14. MN EMS Resources <ul><li>78% of Minnesota EMS personnel are volunteer </li></ul><ul><li><40% of EMS personnel rated EMS as their 1 st priority in a disaster </li></ul>
  13. 16. N95’s ( Estimated hospital inpatient need) <ul><li>Assume mask use for 2 hours on average </li></ul><ul><li>Does not include home care, ACS, family, …. </li></ul><ul><li>Estimate of 275 masks / inpt bed for 8 week pandemic duration for direct patient care delivery </li></ul><ul><li>3,300,000 N95s for usual operational bed capacity in MN over 8 weeks </li></ul>
  14. 17. Community- Based Surge <ul><li>Clinics </li></ul><ul><li>Homecare </li></ul><ul><li>Nursing homes </li></ul><ul><li>Procedure centers </li></ul><ul><li>Family-based care </li></ul><ul><li>Alternate Care Sites </li></ul><ul><li>Flu Centers </li></ul>
  15. 19. Flu Centers <ul><li>Provide a consistent assessment of patients with influenza symptoms. </li></ul><ul><li>Triage and refer patients. </li></ul><ul><li>Provide access to self-care information & treatment for lay home care. </li></ul><ul><li>Distribute medications as appropriate </li></ul>
  16. 20. Overarching Goal for Scarce Resource Allocation <ul><li>Do the greatest good for the greatest number of persons you can based upon the resources available </li></ul>
  17. 23. Patient Care Strategies for Scarce Resource Situations TOOL KIT <ul><li>Oxygen Conservation Strategies </li></ul><ul><li>Medication Utilization Strategy </li></ul><ul><li>Hemodynamic Support and IV Fluids </li></ul><ul><li>Mechanical Ventilation </li></ul><ul><li>Staffing </li></ul><ul><li>Nutrition </li></ul><ul><li>Documents can be found at: </li></ul><ul><li>http://www.health.state.mn.us/oep/healthcare/index.html#pandemic </li></ul>

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