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Surge Capacity Management Plan Presentation to Ontario’s Registered Respiratory Therapists Critical Care Secretariat November 30, 2009. Agenda. Overview of Surge Capacity Management Plan Ventilator Procurement and Distribution Moderate Surge Response-Ventilator Process - PowerPoint PPT Presentation
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Surge Capacity Management Plan
Presentation to Ontario’s Registered Respiratory Therapists
Critical Care SecretariatNovember 30, 2009
Agenda
1. Overview of Surge Capacity Management Plan
2. Ventilator Procurement and Distribution
3. Moderate Surge Response-Ventilator Process
4. Provincial Ventilator Stockpile
5. Next Steps: Ventilator Strategy
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Surge Capacity Management Program
What are we achieving?
Surge Capacity Management Framework
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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Ontario’s Plan of Action- HSAA Key Response Principles
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
Moderate Surge Response Framework
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Index Hospital Moderate Surge Escalation
Index hospital activates minor surge plans
Expand Capacity to 115%
Critical Care Gatekeeper informs Senior Management of minor event surge event
Hospital CEO /Delegate notifies CritiCall and triggers the LHIN Moderate Surge Response Plan
Index hospital critical care capacity is exhausted or patient safety is
compromised
•Hospital CEO or delegate identifies:
The current situationThe 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
Moderate Surge Response Framework
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Partner Hospital Response
*Details on required information will be provided
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
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.
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
Host Hospitals for Provincial Ventilator Stockpile
LHIN HOST HOSPITAL
Central West William Osler Health Centre
Toronto Central University Health NetworkSunnybrook Health Sciences CentreSt. Michael’s Hospital
North Simcoe Muskoka The Royal Victoria Hospital of Barrie
North West Thunder Bay Regional Health Sciences Centre
North East Sudbury Regional Hospital – Laurentian Site
Central North York General Hospital
Champlain The Ottawa Hospital
Central East Lakeridge Health Corporation
Erie St.Clair Hotel-Dieu Grace Hospital
Waterloo Wellington Grand River Hospital
South East Kingston General Hospital
HNHB Hamilton Health Sciences Corporation – General Site
Mississauga Halton Milton District Hospital
South West London Health Sciences Centre
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
• 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
Moderate Surge ResponseVentilator Process
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 LHIN’s 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.
Provincial Ventilator Stockpile-Maintenance
• The host hospital is responsible to ensure ventilators and accompanying equipment is maintained according to the vendor’s 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.
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.
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: 416-340-4800 ext 2767– BB: 416-399-1173– [email protected]
• Laura Pus– Phone: 416-340-4800 ext 2766– [email protected]
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Emergency Management Branch• Adam Miller
– Phone: 416-212-7062– [email protected]
• Donna Dupont– Phone : 416-212-4465– [email protected]