ED surge
- Maintain patient access across the acute care and urgent care sectors
- Encourage or make available, primary care alternatives to the ED
- Ensure appropriateness of transer of patients to the hospital from long-term care using institution specific referral guidelines (e.g., LTC physician to call ED prior to sending patients for assessment, treatment, or admission)
- Establish Rapid Assessment Zones (RAZ) or Rapid Assessment Fast Track Units (RAFT) for ILI patients
- Establish Short Stay Units (could also be called observation units, assessment units, or clinical decision units)
- Screen all patients with FRI, ILI, or ARI for emerging or travel related infections disease (e.g., MERS) using a risk assessment tool
- Establish early NP swab collection and in-hospital PCR testing for ILI patients and all patients presenting with exacerbation of chronic or acute disease to facilitate cohorting of influenza patients
CC Surge
- Establish criteria for accepting admissions to the CCU, including accepting transfers
- Establish in advance of influenza season a triage protocol with inclusion and exclusion criteria for ventilator support, which takes into account biomedical ethics in the in the event of ventilator shortages
- Increase supply of nursing staff and allied health professional (RT and DI) to manage additional open surge beds
- Redistribute ratios of critical care staff (RN, RT, MD) within CCU to increase unit efficiency (e.g., establish a care team model)
- Implement coordinated strategy between the Rapid Assessment of Critical Events (RACE) team and CCU when CCU is experiencing bed shortage (stablize patients on ward, no transfer)
Resources
- Make available additional beds (transfer ALC patients, discharge stable patients, create "flex-beds")
- Establish phased deferral of elective and non-emergent health services where no severe adverse health consequences are anticipated (strategy for prioritizing deferrals)
- Elective inpatient surgeries and procedures
- Elective outpatient surgeries and procedures
- Outpatient clinics
- Maintain or increase available additional staff:
- Administrative staff
- Nursing staff
- Laboratory staff
- Diagnostic Imaging staff
- Allied Health Professionals (e.g., RT, OT, PT)
- Environmental Health staff
- Hospital support staff (e.g., orderlies)\
- Address staffing shortages by:
- redeploying staff from deferred services,
- deferring staff holidays,
- establishing extra shifts,
- paying overtime, and
- training non-clinical staff for influenza care and other essential services.
- Stockpile anti-virals and antibiotics
- Use ventilator capacity anywhere in the hospital where sufficient oxygen capacity exisits (e.g., ER, post-anesthetic care units)
Infection prevention and control
- Provide appropriate PPE and re-train staff in proper use
- Post hand hygiene and cough etiquette signage
- Establish and encourage non-pharmaceutical measures to prevent transmission of influenza: hand hygiene, respiratory hygiene, fomite disinfection, social distancing, disposable face masks
- Isolate confirmed or suspected influenza patients in private or semi-private rooms (cohorting patients)
- Establish separate waiting and treatment areas for ILI and non-ILI patients
- Increase environmental services cleaning ED, CCU, and other areas with high volume or patients
Occupational Health
- Provide enhanced education and training for workers and supervisors in advance of influenza season
- Offer N95 mask refitting and re-training in advance of influenza season
- Monitor for appropriate IPAC housekeeping practices
- Promote early immunization of health care workers
- Establish process to communicate to staff to stay home when they are sick
Communication
- Contact KFL&A Public Health for questions or advice on surveillance, circulating viruses, vaccine effectiveness, vulnerable demographics, etc.
- Monitor surveillance updates on influenza from KFL&A Public Health (or other sources)
- Communicate with the public (manage flu at home, stay home when ill, prevention, immunization, where to get medical assessment) via:
- Newsletters or notices
- Posters
- Web-site
- Newspaper
- Media release
- Communicate with hospital staff via:
- Newsletters or notices (electronic or paper)
- Posters
- Web-site
- Staff meeting
- Screen savers
- Communicate with health partners via:
- Newsletters or notices
- Web-site
- Teleconferences and meetings
- Informal correspondence
- Establish a coordinated and positive media communication plan in advance of influenza season
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