Surge Capacity Management Plan Presentation to Ontarios Registered Respiratory Therapists Critical C

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Surge Capacity Management Plan Presentation
to Ontarios Registered Respiratory
TherapistsCritical Care SecretariatNovember
30, 2009
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Agenda

• Overview of Surge Capacity Management Plan
• Ventilator Procurement and Distribution
• Moderate Surge Response-Ventilator Process
• Provincial Ventilator Stockpile
• Next Steps Ventilator Strategy

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Surge Capacity Management Program
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Surge Capacity Management Framework
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Surge Capacity Management Elements

• Foundation of the plan
• Standardized practice for planning
• Ensure a consistent application of the framework
  during surge response

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Ontarios Plan of Action- HSAA Key Response
Principles
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Minor Surge Plan

• Hospital Teams
• Established plans for the 5 elements of the surge
  capacity management
• Ensure the surge response plan follows the
  outlined principles
• Ensure the operations are scalable and flexible
  to 15 above the normal critical care capacity
• Share information with the LHIN and partnering
  LHIN hospitals to develop inventory of resources
• Utilize CritiCall to facilitate the transfer to
  another organization in the LHIN or across the
  province

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Moderate Surge

• Defined as an increase in demand for critical
  care services that goes beyond individual
  hospitals and impacts on a Local Health
  Integration Network (LHIN)
• A system-level approach applicable in all
  surges.
• Aimed at sustaining critical care services in a
  time where demand exists the capacity or
  capability of the hospital and regional resources
  are required
• Hospital capacity 115 or patient safety
  compromised

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Moderate Surge Response Framework
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Index Hospital Moderate Surge Escalation

Critical Care Gatekeeper informs Senior
Management of minor event surge event

• Hospital CEO or delegate identifies
• The current situation
• The actions taken in the organization to mitigate
  the escalation ( minor surge response)
• The actions required during the moderate surge
  response,
• Specifically the services and resources necessary
  to sustain patient's) access to critical care in
  the organization and /or across the LHIN

Index hospital activates minor surge
plans Expand Capacity to 115
Index hospital critical care capacity is
exhausted or patient safety is compromised
Hospital CEO /Delegate notifies CritiCall
and triggers the LHIN Moderate Surge Response
Plan
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Moderate Surge Response Framework
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Partner Hospital Response
Details on required information will be provided
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Ventilator Inventory

• Ventilator Survey- August 2009
• For the 131 hospitals with ventilator capacity
  the following information has been identified
• Total number of invasive ventilators 1832
• 1537 in use and 282 in storage
• excludes HFO, operating room and portable
  ventilators
• Total number of invasive ventilators including
  HFO, operating room and portable ventilators
• 3215
• Total HFO reported across the province - 74

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Ventilator Procurement Distribution

• The goal of the ventilator stockpile is to
  enhance critical care ventilator capacity across
  the province and provide hospitals with the
  ability to respond to unexpected increases in
  critical care patient volumes.
• 216 ventilators were procured by the province to
  assist with Provincial Surge Capacity Management
  Plan
• Ventilators were allocated to each LHIN across
  the province
• based on current ventilator capacity
• analysis of specific variables from CCIS relating
  to capacity, location and services provided

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Ventilator Procurement Distribution

• The Ministry has procured the following three
  ventilator models to accommodate the needs of all
  patient populations
• PB840 (Tyco Healthcare)
• Avea (Viasys Health Care)
• Evita XL (Drager Medical)
• Each ventilator provides the capability to
  ventilate neonates, pediatrics and adults and
  provides basic and advanced modes such as Airway
  Pressure Release Ventilation (APRV). Specific
  details regarding ventilator capabilities will be
  provided directly by the vendor.
• All ventilators are equipped with a N100
  expiratory filter system for infection control
  purposes.

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Ventilator Procurement Distribution

• Ventilators will be stored in host hospital in
  each LHIN to ensure that hospitals requiring
  additional ventilators receive them in a timely
  manner
• Host hospitals will have an asset agreements
  with MOH outlining accountabilities
• Ventilators will be made accessible to Ontario
  hospitals when all available resources within the
  LHIN have been considered
• Any hospital in the province will have access to
  the provincial stockpile according to the process
  identified in Moderate Surge Planning
• Receiving hospitals will receive an asset
  agreement prior to access to the stockpile
  outline accountabilities

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Host Hospitals for Provincial Ventilator Stockpile
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Moderate Surge ResponseVentilator Process
Index hospital is approaching their maximum
ventilator capacity and has considered all
organizational vent capacity
Index hospital notifies CritiCall
CritiCall facilitates teleconference between CC
LHIN Lead Index hospital
Predetermined LHIN equipment sharing plan
actioned/ CC LHIN Lead identifies potential
resources within the LHIN
When all local equipment measures are exhausted
the CC LHIN Lead will notify CCS for ventilator
equipment options
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Moderate Surge ResponseVentilator Process

• Each hospital will take measures to ensure there
  is an adequate four week supply of equipment and
  resources to sustain their critical care units as
  functional
• Each hospital will ensure current supply of
  ventilators are maintained and the ventilator
  inventory is current
• Each hospital will verify the functionality of
  all ventilators in storage and identify which
  ventilators from storage can be utilized during a
  time of increasing demand.
• In addition to ventilators in operation the
  ventilators in storage would be checked and
  verified for functionality

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Moderate Surge ResponseVentilator Process

• In addition to ventilators in operation the
  ventilators in storage would be checked and
  verified for functionality
• Organizations would share equipment at a LHIN
  level prior to expanding to other LHINs or the
  province
• Equipment sharing agreement
• Tracking tools

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Provincial Ventilator Stockpile

• Each ventilator will come equipped with
  supporting equipment such as a heated humidifier,
  temperature probe and humidifier cable, as well
  as disposable equipment such as circuits and
  humidifier pots.
• The following tests are required prior to the
  ventilator being put into circulation for
  clinical use and results be must be documented by
  the hospital
• Standard Biomedical Check (done by vendor or
  hospital Biomedical Engineering Department if
  accredited to perform)
• Electrical Safety Testing by hospital Biomedical
  Engineering Department
• Acceptance/Functionality Testing by Respiratory
  Therapy Department
• Service manuals will be provided for all
  ventilators and humidifiers as well as
  information on equipment reprocessing.

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Provincial Ventilator Stockpile-Maintenance

• The host hospital is responsible to ensure
  ventilators and accompanying equipment is
  maintained according to the vendors maintenance
  schedule.
• Ventilators are currently under warranty to the
  manufacturer and includes access to preventative
  maintenance servicing
• Hospitals must notify the Critical Care
  Secretariat before doing any sort of preventative
  maintenance beyond what the manufacturer
  provides.
• Hospitals must notify the Critical Care
  Secretariat of any malfunctions or damage to the
  ventilators that occurs at any time. Proposed
  repairs will be assessed by the Critical Care
  Secretariat and coordinated with the vendor.

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Provincial Ventilator Stockpile-Training

• Each vendor will provide access to ventilator
  clinical training services, educational resources
  and on-line technical support for Respiratory
  Therapy staff and/or Biomedical Engineering staff
  at no additional charge 24 hours per day.
• Hospitals are required to follow their internal
  policy guidelines and directives regarding
  ventilation.
• Access to clinical advice, protocols and support
  networks in circumstances such as ventilating
  unfamiliar patient populations or use of new
  ventilation modes should be addressed at the
  professional level.

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Next Steps

• MOHLTC will distribute instructions for host
  hospitals
• to identify a contact person that will be
  available 24hours a day, 7 days a week that can
  be contacted to release a ventilator(s) from the
  provincial stockpile
• to identify the training requirements for models
  unfamiliar to the organization from the stockpile
  
• Priority will be given to host hospitals
• Webinar will follow for all receiving hospital
  Respiratory therapy teams, Critical Care Units
  and Hospitals Administrators

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Thank you!

• Success always comes when preparation meets
  opportunity!

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Contact Information

• Critical Care Secretariat
• Julie Trpkovski
• Phone [phone] ext 2767
• BB 416-399-1173
• Julie.Trpkovski_at_ontario.ca
• Laura Pus
• Phone [phone] ext 2766
• Laura.pus_at_uhn.on.ca

• Emergency Management Branch
• Adam Miller
• Phone [phone]
• Adam.miller_at_ontario.ca
• Donna Dupont
• Phone [phone]
• Donna.dupont_at_ontario.ca