Covid 19

Clinical & Operational Plans

Team Briefing

Phase 1 Response

4 broad actions during March & April

1. Prioritised and reduced elective work programme

2. ITU surge plan to accommodate rapid demand for ventilated beds

3. Re-design of inpatient management (24/7 rotas)

4. ED divert to load balance downstream ITU demand

Phase 1 Response

Enabled by

• Vastly reduced non-covid clinical activity

• Re-purposed clinical and admin teams

• Staff welfare and well-being efforts

Surgical Capacity Elective (OP and IP) activity currently at 25% of normal levels

OP referrals 1/3rd of normal

Successful IS collaboration over three weeks

National contract for 14 weeks

Currently utilising:

• Parkway, Little Aston, Dolan Park, Priory, Westbourne

• approx 5 theatres per day

Internal capacity severely constrained

• GHH & BHH CEPOD, QEHB 5 theatres daily

UHB current inpatients 27th April

0

100

200

300

400

500

600

700

800

Inpts

ITU

Phase 2 Response

May onwards – priorities:

• Implement 18 month plan – adaptability is key

– Maintaining ITU access for covid management

– Patient cohorting - bed occupancy

– Revised model of Acute Care

• Increasing elective access – graduated & flexible

How? Build on what we’ve learnt so far:

1. Re-purposing of hospitals and staffed to meet their core purposes

2. Resilient ITU staffing to sustain covid access for the duration

3. Benefit of generalist v specialist model

Other major considerations

Staff health and well-being support via prolonged interventions

Maintaining access to IS and other NHS facilities

Model for delivery of outpatients

Access to diagnostics

Pre-op assessment and screening

ITU is the critical dependency

Options

• Amb care

• 7 theatres

• 2 procedure rooms

• 24 beds

• 56 trolley spaces

• Consultation / assessment rooms / OPD access

• Clean access separate to main access

• Close to imaging, cath lab, IR rooms

• Must maintain Level 3 services

QEHB

Options • Solihull

– Can be a ‘clean site’

– 7 theatres

– Cath lab

– Imaging

– In patient beds - 238

– HDU / ITU could be expanded

• AMU and Medical Inpatient Wards

– 2 week phase down from present use

– Transfer take to BHH

• Good Hope DCU

• BHH hybrid theatre

Phase 2 – Repurposing Hospital Inpatient Care

BHH

• ITU NEL Covid & non-covid.

• Revised model of Acute Care

GHH

• ITU NEL Covid & non-Covid.

• Revised model of Acute Care

QEHB

• ITU NEL Covid & non-covid.

• Revised model of Acute Care

• Level 2 & 3 elective care

SOL

• Level 1+ / 2 elective theatres

• Elective wards

• Non-ward based services

Front door and inpatient management teams at hospital level for NEL – ‘hot teams’

Elective inpatient management - ‘cold teams’

Increased ITU capacity for covid and non-covid / NEL and EL patients

Plan

• Max out IS capacity May and June

– Support with UHB staff as and where possible

– Could increase capacity by 75-100%

• Develop and implement phase two changes

– Aim for 1st June to be fully operational

– Allow staff recovery time and ongoing support

Discussion time