Are you prepared for a pandemic? Leading facilities share how to gear up
Are you prepared for a pandemic? Leading facilities share how to gear up
Outpatient surgery has role to play during patient surges
When Fatal Contact: Bird Flu in America aired this spring on ABC, many health care providers dismissed the movie as pure, exaggerated fiction about what could happen in terms of a pandemic or other patient surges.
Or is it?
Officials at the Centers for Disease Control and Prevention, in responding to issues raised about pandemic flu in the movie, point out that some scenarios portrayed in the movie are likely to happen. What's more, some of those scenarios are likely to affect outpatient surgery providers. According to the Department of Health and Human Services1:
- The film does depict scenarios that could unfold should a severe pandemic develop, including limited availability of antivirals and vaccines as well as the potential for disruption of supplies, medicines, and other essential services.
- A substantial percentage of the world's population will require some form of medical care. Health care facilities can be overwhelmed, which would create a shortage of hospital staff, beds, ventilators, and other supplies.
- The numbers of health care workers and first responders available to work will be reduced as they will be at high risk of illness through exposure in the community and in health care settings, and some may have to miss work to care for ill family members.
- In some good news, medical workers and public health workers who are involved in direct patient contact, other support services essential for direct patient care, and vaccinations (8 million to 9 million) would be among the first individuals to receive the vaccine, if available.2
Outpatient surgery managers who don't think a pandemic would affect them are "missing the mark," says James McGowan, DHA, administrator of the perioperative region at University of Virginia (UVA) Health Sciences Center in Charlottesville. Every health care setting would be affected as the country struggled to deal with a large volume of very sick patients, he maintains. "It's hard to understand how any health care facility, an ambulatory surgery center or any other type, will not be affected."
So what should outpatient surgery managers be doing to prepare? Take steps to limit the spread of respiratory illnesses. Consider these other suggestions from those health care facilities at the forefront of preparations for pandemics and other emergencies:
• Prepare your outpatient surgery areas to handle patient surges.
In a pandemic or other emergency that causes a sudden patient surge, elective cases already in motion would be ended quickly, in line with regional emergency management plans, McGowan says. Scheduled elective cases would be canceled, he adds.
Perioperative areas usually are well suited to handle patient surges, McGowan points out. "Just the nature of our book of business in the OR and pre- and post-care areas is that we are surging every day," he says. At McGowan's facility, the admission rooms for the ORs already are set up similarly to patient care rooms, and the recovery areas are located almost adjacent to the surgery admission suites. "With the combination of an area like that, if we had an influx of patients and needed to care for them quickly, if we need to handle isolation patients — and a pandemic almost assuredly would present us with those — our preoperative area and that of most hospitals in similar regions could serve as a pretty quick initial surge area," he says.
At UVA Health Sciences Center, the main OR is in proximity to the ED and inpatient areas and probably would serve as a holding area for higher-acuity patients, McGowan says. The hospital also has a freestanding surgery center, he says. "We would take lower-acuity patients and use the outpatient center for that type of care."
• Prepare your staffing.
UVA Health Sciences Center also has developed a central staffing pool, and they have incorporated that pool into their surge capacity plan.
"By surge, I mean how far and by how many beds can we expand hospitals to take care of those patients thrust upon us by a national emergency . . . or a pandemic that is slower in coming but has droves of patients a few days later?" McGowan says. "We use that pool every day to handle our [normal] surges," he adds.
• Prepare to move outpatient surgery staff to other areas.
In any pandemic situation, expect 30%-40% absenteeism, due to staff being sick, taking care of sick family members, or not wanting to work, advises Linda Burton, BSN, CIC, infection control practitioner at the University of Colorado Hospital, Denver. The expected absenteeism means that outpatient surgery staff members are likely to be shifted to other areas to assist in patient care, Burton says. For this reason, outpatient surgery staff members at her facility are among those designated to receive antivirals and/or vaccines, if available and needed, she says.
"We're going to train them for cross over," Burton says. Outpatient surgery staff may even be trained for clerical duties, she says. "Everyone will have to pitch in. There are going to be absences everywhere, all the way down to guys at the warehouse where you get your supplies." Staff who are Class C licensed potentially could be used to drive trucks, Burton adds.
At press time, University of Utah Hospital in Salt Lake City was preparing to survey employees to determine how many would be willing to come to work in a pandemic and if not, why, says Colleen Connelly, RN, BSN, emergency preparedness manager. The hospital will look at how many employees would need protective equipment and prophylaxis.
• Educate your staff.
Nashville, TN-based Vanderbilt University Medical Center performs annual competencies on communicable diseases. Influenza is but "one of several options that could show up on our door at any time," says Nancye Feistritzer, RN, MSN, assistant hospital director of perioperative services.
Outpatient surgery staff members need to be able to recognize the signs of influenza, Burton says. "You could have someone scheduled for surgery and they come in coughing, with flu symptoms," she warns. "They need to know what to do to protect themselves and who to call."
University of Colorado Hospital is developing a dedicated web site on pandemics, Burton says. That web site will explain what to do during a pandemic, who to call, and how to follow the emergency plan in each department, she says. Unit-based clinical educators will be educating staff as units and, when needed due to irregular work schedules, will be educating individuals, Burton says.
UVA Health Sciences Center educates staff at least twice a year on its emergency preparedness plan. "When we go through training, we test how many people we can get responding to the hospital when we do a drill," McGowan says. The OR and freestanding ASC are involved as the hospital has a variety of mock patients overwhelm the ED, he says.
Additionally, drill your staff on pandemics so they can practice those plans. Vanderbilt conducted one drill specific to SARS, says Feistritzer. By conducting that drill, staff learned about proper use of personal protective equipment, the importance of hand and respiratory hygiene as a role in prevention, how to establish effective communication with appropriate agencies such as the state Department of Health and the Centers for Disease Control and Prevention, what issues surrounded patient/family isolation — such as the impact on staff schedules, communication issues with families, and coordination of public information from the Department of Homeland Security.
Burton's facility has a steering committee that has been meeting for more than six months to prepare for pandemics. "We're getting ready for anything that flops out of the sky at us to include a resurgence of SARS, even maybe smallpox," she says. "Who knows? In this day and age, you stand back and hold on."
The repercussions could be serious if you ignore the potential threat or your program's ability to respond appropriately, sources says. "Regulatory agencies and state health departments and Home-land Security are assessing institutions' ability to deliver that," Feistritzer says. "Their medical/legal liability if they should fail to have appropriate response is pretty significant." (For more information on preparing for a pandemic flu, hospitals should go to www.hhs.gov/pandemicflu/plan/sup3.html.)
References
- Department of Health and Human Services. ABC TV Movie: Fatal Contact: Bird Flu in America. Washington, DC. Accessed at www.pandemicflu.gov/news/birdfluinamerica.html.
- Department of Health and Human Services. Table D-1: Vaccine Priority Group Recommendations. Washington, DC. Accessed at www.hhs.gov/pandemicflu/plan/appendixd.html.
Sources/Resources
For more information on preparing for a surge of patients, contact:
- Linda Burton, BSN, CIC, Infection Control Practitioner, University of Colorado Hospital, 4200 E. Ninth Ave., MB C-300, Denver, CO 80262-0001. Phone: (303) 372-7855. Fax: (303) 372-7854. E-mail: [email protected].
- Colleen Connelly, RN, BSN, Emergency Preparedness Manager, University of Utah Hospital, Salt Lake City. E-mail: [email protected].
- Nancye Feistritzer, RN, MSN, Assistant Hospital Director of Perioperative Services, Vanderbilt University Medical Center, 1161 21st Ave. S., Nashville, TN 37232. Phone: (615) 322-3354. Fax: (615) 343-1500. E-mail: [email protected].
- James McGowan, DHA, Administrator of the Perioperative Region, University of Virginia Health Sciences Center, Box 800688 Lane Road, Charlottesville, VA 22901. E-mail: [email protected].
For more information on preparation for pandemics, see:
- Center for Infectious Disease Research & Policy. Web: www.cidrap.umn.edu.
- Centers for Disease Control and Prevention. Web: www.cdc.gov/flu/avian.
- Department of Health and Human Services. Web: www.pandemicflu.gov. Click on "health care planning."
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.