Download - OPERATIONAL INFRASTRUCTURE
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OPERATIONAL INFRASTRUCTURE
[ENTER FACILITATOR’S NAME AND CONTACT INFORMATION]
Developed by Troutman Sanders LLPDeveloped for the Virginia Department of Health
Funded by Centers for Disease Control and Prevention
3Operational Infrastructure
Toolkit Presentations Instructions for Use
Toolkit Presentations are intended to be a companion to the Hospital Implementation Guide and should not be used in isolation.
The Presentations are intended to serve as a starting point for the facilitator. The facilitator should thoroughly review the Presentation prior to use in Implementation Team, CRAG or Subcommittee meetings and customize the Presentation to meet the unique needs of the meeting participants.
Pay particular to attention to the information provided in brackets ([ ]), which must be completed by the facilitator prior to use.
Included in the “Notes” section of each slide are the following types of information:
• Slide Type, which indicates whether the slide is for information or discussion, serves as a placeholder, or is some combination thereof
• Planning Guide Section(s), which will direct the facilitator to the corresponding sections of the Planning Guide and Hospital Implementation Guide for further information
• Special Instructions, which provides directions for the facilitator to customize the slide for the intended audience
• Speaker’s Notes, which provides more detailed information to supplement the material on the slide
Refer to the Hospital Implementation Guide for further guidance and helpful hints on effectively completing the process described in the Planning Guide.
5Operational Infrastructure
Add slides from Altered Standards Overview and/or Chapter 1 presentation, as needed, to re-introduce the CRAG to the concept of altered standards and critical resource shortage response planning, especially if new members are involved.
7Operational Infrastructure
Why do we need an Operational Infrastructure?
Many hospitals already have an emergency response infrastructure
Most hospitals do NOT have the type of infrastructure that will be needed to respond to a critical resource shortage event
An overall operational infrastructure will provide consistency to Protocol development, implementation, and operationalization
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Chapter Overview
Determine process for activation and termination of the CRSRP
Determine process for activation and termination of each Protocol
Develop structure for making resource allocation decisions
Develop infrastructure for reviewing and revising CRSRP during a CRSE
Define “essential documentation”
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Chapter Overview cont.
Develop process for responding to non-compliance
Identify resources for psychological and emotional support
Develop a communication plan Develop strategy for providing palliative care
during a critical resource shortage event• Determine goal• Develop standard definition• Identify mechanisms for providing palliative care
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Strong Foundation
Ethical Framework
Operational Infrastructure
Education & Communication
Building the CRSRP
Protocol
Protocol
Protocol
Protocol
Protocol
Protocol
Protocol
Protocol
Ad Hoc
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[HIGH PRIORITY [HIGH PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[HIGH PRIORITY [HIGH PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[HIGH PRIORITY [HIGH PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[HIGH PRIORITY [HIGH PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[MEDIUM PRIORITY [MEDIUM PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[MEDIUM PRIORITY [MEDIUM PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[MEDIUM PRIORITY [MEDIUM PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[MEDIUM PRIORITY [MEDIUM PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[MEDIUM PRIORITY [MEDIUM PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[LOW PRIORITY [LOW PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[LOW PRIORITY [LOW PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[LOW PRIORITY [LOW PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[LOW PRIORITY [LOW PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[LOW PRIORITY [LOW PRIORITY ETHICAL VALUE]ETHICAL VALUE]
[Withdrawal/Withholding] [Withdrawal/Withholding] of Resourcesof Resources [Exclusion Criteria][Exclusion Criteria]
[INSERT GOAL DEVELOPED IN [INSERT GOAL DEVELOPED IN SECTION 3.2]SECTION 3.2]
Ethical FrameworkOperational Infrastructure
Ethical Framework
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What’s Next?
Ethical Framework
Operational Infrastructure
Development of the operational infrastructure
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Activation Flow Chart
Event Occurs
Identify Critical Resource Shortage
Event
Report Critical Resource Shortage
Event
Declare Critical Resource Shortage
EventActivate CRSRP
Who is responsible for each step in the activation process?
Resource levelsbegin to diminish &demand increases
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Identifying a Critical Resource Shortage Event
STATUS
Does demand exceed supply?
FORECAST
When will demand exceed supply if it doesn’t already?
DURATION
For how long will demand exceed
supply?
MAGNITUDE
To what extent does or will demand exceed supply?
MITIGATION
Options for obtaining additional supplies of
the resource.
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Declaration and Activation
Supply of the Resource
Who will declare the CRSE?
Who will activate the CRSRP?
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Governmental Emergency Declarations
How will federal, state or local emergency declarations be identified?
Who will find, read and summarize the declaration(s)?
What is the role of legal counsel?
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Protocol Termination Options
Simultaneous
Asynchronous• Who will terminate the Protocols? • Will the decision vary by Protocol?• What information is required?
Termination by Tier
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ED
Inpatients
Direct Admits
ELIGIBLE
INELIGIBLE
Model 4Model 4Triage Triage
Officer and Officer and Triage Triage
CommitteeCommitteeResource #1
Resource #2
INE
LIG
IBLE
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Triage Officer Powers
AUTHORITY YES NO
Recommend resource allocation
Withdraw resources from patients and re-allocate
Research/monitor outcomes
Situational Awareness
Re-assess and modify Protocols
Require physicians and staff to provide care according to Protocol
Reprimand non-compliant providers
Other?
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Triage Committee Powers
AUTHORITY YES NO
Recommend resource allocation
Withdraw resources from patients and re-allocate
Research/monitor outcomes
Situational Awareness
Re-assess and modify Protocols
Require physicians and staff to provide care according to Protocol
Reprimand non-compliant providers
Other?
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Reassessment of CRSRP
Implementation of CRSRP
Re-assessment of situational
factors
Revisionof CRSRP
Disseminationof CRSRP
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Documenting CRSRP Modifications
Re-assessment of situational
factors
Revisionof CRSRP
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Primary Functions of Documentation During a CRSE
Care and safety of patients Support Protocols Quality assessment Obtain timely reimbursement
How will you ensure the completion of “essential documentation”?
Essential DocumentationEssential Documentation
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Reasons for Non-Compliance
That is outside my
scope of practice.
I don’t have the knowledge or
skills to successfully
complete this task.
My patient deserves to receive the resource.
The triage committee used the Protocol incorrectly.
My patient,my
responsibility,my decision.
I won’t do that because I don’t want to get sued.
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Non-Compliant ProvidersHow will you respond?
Ignore Terminate employment/
revoke privileges
Assume controlof patient
Counseling/Persuasion
Directive Restrict/suspend
privileges
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Palliative Care “Normal” v. Disaster
“Normal” Times End-of-life care
Performed by select group of providers
Patient choice
CRSE Patients who in “normal” times would have received regular care Providers who are not used to this type of care Little, if any, patient choice
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Potential GoalsTo relieve painTo manage symptoms without use of the
critical resourceTo ensure that patients are not abandoned
or ignoredTo minimize the physical/psychological
suffering of those not provided the critical resource
Others?
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Define Palliative Care
Definition is important for consistency and understanding
Will be informed by the goals established in this meeting
No existing definition really captures palliative/comfort care in the disaster context
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Providing Palliative Care
Who will provide palliative care?Can we partner with existing local
palliative care organizations?What training will be needed?Can palliative care be provided in
alternate care facilities?How will psychological/emotional support
be provided to palliative caregivers?