Planning for Surge Capacity in Healthcare Services


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  • NOTE: Medicare or Medi-Cal beneficiaries must be aware of the administrative and financial implications of the specific waivers and any applicable steps that need to be taken by hospital to fully benefit from waivers and declarations.
  • Planning for Surge Capacity in Healthcare Services

    1. 1. Planning for Surge Capacity in Health Care Services Betsey Lyman Deputy Director, Public Health Emergency Preparedness California Department of Public Health
    2. 2. California Faces Disasters on a Regular Basis <ul><li>Examples of disasters since 2006: </li></ul><ul><ul><li>2006 Extreme Heat </li></ul></ul><ul><ul><li>2007 Lake Tahoe Wildfire </li></ul></ul><ul><ul><li>2007 Southern California Wildfires </li></ul></ul><ul><ul><li>2008 Northern California Wildfires </li></ul></ul><ul><ul><li>2008 Chino Hills Earthquake </li></ul></ul><ul><ul><li>2008 Los Angeles Metro Link Crash </li></ul></ul><ul><ul><li>2008 Southern California Wildfires </li></ul></ul><ul><ul><li>2008 Severe Cold </li></ul></ul>
    3. 3. The Challenge <ul><li>Meeting the public health and medical needs of Californians during and following disasters </li></ul><ul><li>Addressing statewide needs during a catastrophic event when mutual aid is limited </li></ul>
    4. 4. <ul><li>…… an excess in demand over capacity in hospitals, long-term care facilities, community care clinics, public health departments, other primary and secondary care providers, resources and/or emergency medical services </li></ul>What is a Healthcare Surge?
    5. 5. <ul><li>The frequent emergency department overcrowding experienced by healthcare facilities (for example, Friday/Saturday night emergencies). </li></ul><ul><li>A local casualty emergency that might overcrowd nearby facilities but have little to no impact on the overall healthcare delivery system. </li></ul>What is NOT a Healthcare Surge?
    6. 6. Surge Capacity Basics <ul><li>Beds : Acute care and critical care beds </li></ul><ul><li>Staffing : Licensed healthcare professionals and </li></ul><ul><li>support staff </li></ul><ul><li>Medical supplies and equipment : pharmaceuticals, personal protective equipment, portable and fixed decontamination systems, isolation beds, ventilators, masks </li></ul>
    7. 7. Measuring the Gap: 2006 California Healthcare Surge Capacity Survey <ul><li>Standardized definitions for crisis care: </li></ul><ul><ul><ul><li>Nurse-to-patient staffing ratio of 1:5 for Critical Care Beds and 1:20 for Other Medical-Surgical Beds </li></ul></ul></ul><ul><ul><ul><li>  Assume self-sustainment within the facility for a minimum of 72 hours without re-supply of equipment, supplies or staff </li></ul></ul></ul><ul><ul><ul><li>Assume 30% of staff will not report to work </li></ul></ul></ul>
    8. 8. Measuring the Gap (cont) <ul><li>Response : </li></ul><ul><ul><li>324 hospital: 80 percent of California’s 73,000 operating licensed acute care hospital beds </li></ul></ul><ul><ul><li>California’s local health departments </li></ul></ul><ul><ul><li>172 community clinics </li></ul></ul><ul><li>Identified 19,963 beds California hospitals said they can surge </li></ul><ul><ul><li>Bed shortages: </li></ul></ul><ul><ul><ul><li>Los Angeles area </li></ul></ul></ul><ul><ul><ul><li>Pediatric beds </li></ul></ul></ul>
    9. 9. Greater Gaps in Meeting Needs of a Catastrophic Event <ul><li>Using CDC’s FluSurge 2.0 computer modeling program for pandemic influenza: </li></ul><ul><ul><li>California needs 58,723 surge beds for a moderate pandemic influenza </li></ul></ul><ul><ul><li>38,760 beds or 194% above the 19,963 surge beds California hospitals said they can surge. </li></ul></ul>
    10. 10. Analysis of 2006 Survey Results <ul><li>California has sufficient surge capacity for a Moderate event: regional earthquake, fire, flood, or bioterrorist attack. </li></ul><ul><li>California’s surge capacity is insufficient for a Catastrophic event: statewide impact, e.g., Katrina-like event or pandemic influenza. </li></ul>
    11. 11. 2006 Healthcare Surge Initiative The State of California spent $172 million to improve its medical surge capacity $5 million     Developing new hospital guidelines and standards $33.4 million 21,000 42,000 21,000 extra beds with supplies for alternate care sites $18.3 million 3 - 200 bed   Mobile Field Hospitals $54.6 million 3.7 million courses 90% Tamiflu, 10% Relenza 8 million courses Antiviral medicines -- enough to treat 25 percent of California's population $30.6 million 2,400 24,000 Ventilators $19.9 million 50.9 million 100 million Masks (N95 Respirators) Cost Bought Need Item
    12. 12. Alternate Care Site Supplies and Equipment <ul><li>State Alternate Care Site Caches contain over 300 items, ranging from patient cots and linens, routine nursing supplies, suture equipment, airway breathing supplies, etc. </li></ul><ul><li>Supplies and equipment are packed in caches to support 50 patients </li></ul><ul><li>Each cache is stored on 20 pallets </li></ul>
    13. 13. Standards and Guidelines for Healthcare Surge during Emergencies
    14. 14. <ul><li>Standards of care for healthcare facilities and licensed healthcare professionals during an emergency </li></ul><ul><li>Liability of healthcare facilities and licensed healthcare professionals </li></ul><ul><li>Reimbursement of care provided during an emergency </li></ul><ul><li>How to operate Alternate Care Sites </li></ul><ul><li>Surge capacity operating plans at individual hospitals </li></ul>Focus of the Project
    15. 15. Project Approach <ul><ul><li>Developing and managing a process that includes government agencies, providers, stakeholders, and other relevant parties as participants in this project. </li></ul></ul><ul><ul><li>Developing written standards and guidelines for delivery of medical care services in a surge environment. </li></ul></ul>
    16. 16. 2008 Deliverables <ul><li>Foundational Knowledge document provides platform for all volumes </li></ul><ul><li>Manuals focused on target audience: </li></ul><ul><ul><li>Hospitals </li></ul></ul><ul><ul><li>Alternate care sites </li></ul></ul><ul><ul><li>Payers </li></ul></ul><ul><li>Reference Manual including legal analysis </li></ul>
    17. 17. Volumes under Development <ul><li>Licensed healthcare professionals, including Crisis Care </li></ul><ul><li>Long term care facilities </li></ul><ul><li>Clinics </li></ul>
    18. 18. When is a Healthcare Surge Declared? Surge Monitoring Guidelines Table Green: Usual day to day status. No assistance required Yellow: Surge managed locally. No assistance required Orange: Additional healthcare assets required within jurisdiction Red: Assistance needed outside local jurisdiction or area. Black: Significant assistance needed outside local jurisdiction. Local Surge Emergency Regional Level Surge Statewide Surge Level Surge Level Green Yellow Orange Red Black Enabling Authorities Regulatory/ Accrediting Agency Waiver Regulatory/ Accrediting Agency Waiver Regulatory/ Accrediting Agency Waiver/ Local Emergency Declaration Local Emergency Declaration Local Emergency Declaration State of Emergency Declaration Federal Emergency Declaration
    20. 20. Hospital Connection to Incident Command System <ul><li>Ensuring hospitals have internal Incident Command Systems </li></ul><ul><li>Community planning: connecting hospitals to local Emergency Response Structure </li></ul><ul><li>Expanding hospital capacity to meet surge needs </li></ul>
    21. 21. Reimbursement <ul><li>Maintaining existing revenue streams is critical to hospitals during a healthcare surge. Key concepts surrounding reimbursement during surge include: </li></ul><ul><ul><li>Advanced planning and collaboration with commercial health plan partners </li></ul></ul><ul><ul><li>Acquiring detailed knowledge of the resources available to hospitals during surge conditions </li></ul></ul><ul><ul><li>Methods to access additional resources from federal and State funded programs </li></ul></ul>
    22. 22. Establishment of a Government-Authorized Alternate Care Site 1
    23. 23. <ul><ul><li>A location that is not currently providing healthcare services </li></ul></ul><ul><ul><li>Will be converted to enable the provision of healthcare services to support, at a minimum, inpatient and/or outpatient care required after a declared catastrophic emergency </li></ul></ul><ul><ul><li>Will help absorb the patient load after all other healthcare resources are exhausted </li></ul></ul>What is a Government-Authorized Alternate Care Site? Types of Government-Authorized Alternate Care Sites <ul><li>Mobile Field Hospitals </li></ul><ul><li>Arenas </li></ul><ul><li>Schools </li></ul><ul><li>Churches </li></ul><ul><li>Shuttered Hospitals </li></ul><ul><li>Stadiums </li></ul>
    24. 24. <ul><li>A government-authorized Alternate Care Site is NOT part of the expansion of an existing healthcare facility, such as </li></ul><ul><ul><li>extensions of general acute care hospitals </li></ul></ul><ul><ul><li>clinics, or </li></ul></ul><ul><ul><li>long-term care facilities </li></ul></ul>What is NOT a Government-Authorized Alternate Care Site? Government-Authorized Alternate Care Sites DO NOT include: <ul><li>Tents set up for patient care in the parking lot of a hospital and under their control </li></ul><ul><li>Sites set up for patient triage by Emergency Medical Services </li></ul><ul><li>Any temporary space set up for patient care under the authority of an existing healthcare facility </li></ul>
    25. 25. 2009: Current Challenges in Surge Capacity <ul><li>Gap in needed surge capacity remains significant </li></ul><ul><ul><li>2006 Healthcare Surge Initiative addressed approximately half of the gap in needed beds </li></ul></ul><ul><li>California hospitals are struggling for financial survival. Loss of hospitals would increase the gap </li></ul>
    26. 26. Current Challenges in Surge Capacity (cont) <ul><li>Unfunded: </li></ul><ul><ul><li>Maintaining surge supplies in operating order </li></ul></ul><ul><ul><li>Refreshing expiring supplies (e.g. pharmaceuticals) </li></ul></ul><ul><ul><li>Updating medical equipment </li></ul></ul><ul><ul><li>Training staff to manage, deploy and operate surge beds </li></ul></ul>
    27. 27. Current Challenges in Surge Capacity (cont) <ul><li>California’s economic situation is resulting in: </li></ul><ul><ul><li>Decreased expenditures for public health, with negative impact on the infrastructure to respond to public health emergencies </li></ul></ul><ul><ul><li>Layoffs of trained Local Health Department staff trained in public health emergency preparedness </li></ul></ul>
    28. 28. Current Challenges (cont) <ul><li>Federal funds are the financial support for public health emergency response capacity </li></ul><ul><li>From 9-11 to current year, California’s federal grants for public health emergency preparedness decreased 25 percent . </li></ul>
    29. 29. Accessing the Standards and Guidelines for Healthcare Surge During Emergencies: http:// /EPO/ CDPHPrograms/PublicHealthPrograms / EmergencyPreparednessOffice/ EPOProgramsServices/Surge/