CHEO s Influenza Pandemic Planning CHIPP Process: Lessons Learned

1. CHEO�s Influenza Pandemic Planning (CHIPP) Process: Lessons Learned CAPHC Teleconference June 27, 2006 Lindy Samson

2. Infrastructure for Pandemic Planning at CHEO Overview of Planning Process Lessons Learned

3. Integrated Levels of Planning

4. Infrastructure of Pandemic Planning Administratively Housed through the Emergency Operations Director Emergency PSU Director Reports directly to VP, Patient Services and Allied Health Designated pandemic planning co-ordinator 0.6 FTE x 1 year Designated Chair of Pandemic Planning: 0.2 FTE x 1 year All planning costs being tracked

5. Core Committee: August 2005 Emergency Department: Operations Director Critical care: Operations Director Mental health: Operations Director Infection Prevention/Control: Medical Director Emergency preparedness: Director Virology laboratory: Clinical Virologist Occupational Health and Safety: Manager Project Co-ordinator: ER RN Infectious Diseases: Chair Human Resources: Manager

6. Core Committee Role Define Goals and Assumptions for CHEO�s planning Estimate influenza burden based on existing models Estimate surge capacity within institution Consult with all areas within the institution Develop reporting template for each area/program Assist each area in identifying the issues and generating solutions/plans for their own area Collate and coordinate PSU/corporate areas plans Liaise with regional, provincial partners ?ongoing role during pandemic as consultant group to IMS incident commander

7. Proposed Timeline Initially thought it would take 6 months But it takes much longer�.. Aim to present working plan to senior exec in September 2006

8. CHEO�s Pandemic Planning Goals To minimize serious illness and mortality from pandemic influenza in children and youth who live in the Region To support CHEO�s staff and physicians during the pandemic period To continue to serve as the tertiary care facility for children/youth of the Region during pandemic To minimize the impact of pandemic influenza on the delivery of essential Health Care Services at CHEO

9. CHEO Specific Assumptions: in addition to those already identified All CHEO staff and physicians will be considered essential during pandemic Estimates of pediatric numbers are very difficult Children < 2 years of age and those with underlying chronic health problems will be at greatest risk Children < 5 years of age will likely be disproportionately affected May be up to 30%

10. Assumptions Vaccine will not be available for first wave Antiviral stockpiling according to provincial direction Patients Staff and Physicians up to 30% of our staff/physicians may be unavailable for work either due to illness, illness in family members or childcare/eldercare issues Self-sufficiency is required as the situation will be global

11. Planning Process: This is on everyone�s radar Presentations to Senior management/Board of Directors�keep them involved and aware Communication to staff/physicians early and often meet with every area of the institution let people voice their opinions/concerns

12. Reporting Template for each area Summary of PSU and General Overview of Impact of Pandemic Issues for Consideration Patient Needs Surge capacity Essential vs non-essential services Staffing Needs Projected number and skill set needed. Will additional staff be required? Will you have surplus staff? Surge Equipment and Supply Needs Space/Storage Needs Proposed Strategies to Deal with Above Challenges in Meeting Needs Resources Required Other Comments/Concerns

13. Infrastructure Group Developed Materials Management, Building Services, IT, Security, Human Resources, Housekeeping, Nutrition Services Brainstorm around the support issues and how best to collaborate internally and with other institutions Space is a key issue Stockpiling of supplies etc

14. Clinical Care Overview of Patient Care/Flow During Pandemic: General Principles Including space utilization Clinical Care co-ordinating Committee bed management team for entire hospital Children/Youth with Pandemic Influenza Triage, ER, Admission, Discharge Management Protocols Children/Youth with non-Influenza Illnesses Prioritizing Essential and non-Essential Services Triage, ER, Admission, Discharge PSU Specific Plans

15. Physical layout of hospital during pandemic Overview of clinical space utilization Separated ED into pandemic and non-pandemic areas Separate rapid triage/treatment area outside of ED entrance non-pandemic, non-urgent ED in clinic areas Critical Care surge capacity Divide unit initially Two additional areas identified for ICU patients Maintain one non-influenza ICU area which will also be used for OR recovery Ward allocations Maintain separate areas by hospital floor ideally Open up new ward areas as needed (medical day unit etc) separate oncology/immunocompromised in-patients

16. Human Resources Staffing and Redeployment: HR manager with operations directors database with needs and skill sets �new models� of care orientation and training development of re-deployment center Labour Relations issues areas/mechanisms to support staff and their families Personal preparedness checklists Housing of staff at hospital Expanded EAP programs

17. Physician Resources Chief of Staff responsible Get physician groups to identify essential vs non-essential services Develop on-call model for each Department/Division Engage community physicians ED, medical wards, critical care each developed separate physician plans model of care numbers required skills required Now in process of collating

18. Communication Plan: Consistent messaging is key Pre-Pandemic Staff & Physicians*** (electronic communications about process) Patients & Families Volunteers & Students Community Partners (local, regional, provincial, National) During Pandemic 24 hour information cycle Daily updates at re-deployment center Post Pandemic

19. Post Pandemic Plan & Debriefing Support/debriefing for CHEO community Ramping up of non-essential clinical services Taking Stock: What was the impact on our institution and staff/physicians/community Lessons Learned: process for debriefing to refine plan

20. Psychosocial Support To develop a corporate mental health response Support for patients and families ER and wards Support for Staff and Physicians Establishing mental health support teams for each

21. Learning Lessons Along the Way Everyone�s initial reactions are the same Decide on assumptions and then keep everyone focused on them assumptions will only be wrong can�t solve the global issues here Consult, consult, consult���.. Think big: try and involve everyone�..we left out some key areas initially Facility planning requires dedicated resources/personnel

22. Lessons Learned Along the Way Many issues can�t be resolved locally Ensure co-ordination with regional, provincial, national plans etc Need to think outside the box Need to look at new care providers/models of care to ensure adequate staffing Plan administrative model to be used (IMS) and then make it pandemic friendly Planning needs to include ramping back up after pandemic

23. Lessons Learned Along the Way Staff Communication re planning is key Emphasize commitment to staff safety Plan for specific education to each group within the institution Each area must develop own plan Involve human resources early Challenge of involving primary care providers

24. Lessons Learned Along the Way The plan will never be finished��. Don�t try and re-create what has already been done Collaboration/sharing is important Pediatric/youth issues are unique and have not been specifically addressed by government to date

25. Potential Roles for CAPHC ? co-ordinate the sharing of information amongst pediatric centers ? develop and disseminate common pediatric pandemic planning principles ? dissemination of planning templates etc