Use ASPR-TRACIE resource to decide, plan for surge from seasonal illnesses


April 1, 2018

In the midst of the worse influenza season in years, HHS’ Office of the Assistant Secretary for Preparedness and Response (ASPR) urged hospitals to reach out to regional or state healthcare coalitions to plan how to manage the ever-growing number of patients showing up with flu-like symptoms.

ASPR has created a fact sheet, which you can download here, of “major considerations healthcare facility emergency planners should take into account when developing patient surge management solutions for longer-duration events, such as weeks to months of managing seasonal illness surge. These considerations are different than those of planning to handle surge from a no-notice, short duration event.”

The fact sheet discusses various strategies, including the use of telehealth and community paramedicine programs, to deal with patient surge, as well as media campaigns to include messaging on when patients should seek care from a primary physician, urgent care center or emergency department.

Document reviews array of issues
The document — which is marked as a “working draft” as of February 12 but was available through ASPR’s Technical Resources, Assistance Center, and Information Exchange (TRACIE) — also discusses the use of temporary surge sites, such as a tent outside the hospital or an area of inside the hospital designated for patients with certain symptoms.

Coordinating response efforts with a local healthcare coalition, emergency operations center, emergency medical services or regional preparedness group can help “manage patient distribution throughout the community,” says the fact sheet.

Preplanning and coordination with such groups can also help defray costs and improve training and response, note leaders at Sharp Grossmont Hospital in La Mesa, Calif., just outside San Diego. Sharp Grossmont was among the first hospitals to deploy a surge tent to deal with overflow when patients with flu symptoms began crowding their ED shortly after Christmas.

Partnerships can ease burden
Sharp Grossmont is part of the regional healthcare coalition, a partnership that proved beneficial both financially and with response coordination and training, say Joe Burdenski and Kevin Gubbe, who are both senior safety management specialists for Sharp Grossmont, and coordinated the recent effort along with Marguerite Paradis, the hospital’s director of Emergency Services and Critical Care.

For instance, the San Diego Disaster Coalition partnered with San Diego County to decide on the type of surge tents and equipment to purchase for each of the hospitals, using grant funds. That allows for continuity of supplies and operations, and has proved beneficial from a training and assistance point of view, say the hospital leaders.

If one hospital needed additional supplies or equipment, then another hospital can assist, knowing that each site uses the same type of tent and supporting equipment, said Burdenski, responding for the group to emailed questions.

“Hospitals should include their local fire department agencies with the certification of their tents and work with local regulatory agencies to inform them of the type of tent(s) being used,” especially in a real world response, writes Burdenski.

Sharp Grossmont has two surge tents available. “One tent can be set up for direct patient care, which may include cots, portable toilets, hand wash stations and medical equipment and the other tent is set up with chairs and tables as needed for patient families.” (See sidebar on p. 5 for more information on Sharp Grossmont’s surge tents.)

Use checklists to develop plan
The 18-page fact sheet from ASPR-TRACIE has several checklists hospitals can use to decide when and how to set up surge sites to care for seasonal illness patients.

For instance, issues to consider when deciding whether to open an on-site surge facility to manage outpatient care might include:

  • Will the demand be sustained long enough to warrant set up?
  • Have you exhausted other options?
  • Expanded to other areas of the hospital/campus (e.g., creating additional outpatient capacity in on-site clinics, same-day surgery, or observation/short-stay areas)
  • Increased and/or redeployed staff
  • Increased throughput by reducing length of stay (e.g., expedited charting, moving patients to “results pending” area after tests obtained)
  • Expanded hours and capabilities of on-site clinics
  • What are the costs?
  • Do you own or will you need to rent/borrow the tent or mobile unit?
  • How much will it cost to operate the surge site in addition to your normal operations (e.g., overtime, additional staffing, generator fuel, lighting, security)?
  • Would the change in treatment site affect reimbursement rates?

Other issues the fact sheet encourages hospitals to consider are how to handle the “optics” of such a surge site, including managing public concerns about the seemingly sudden appearance of a patient care tent, how to train staff to run the on-site facility, and the difficulties of integrating the surge site into your active shooter or evacuation protocols.

The fact sheet also discusses how to ensure smooth operations, how to decide which patients to exclude from the surge site, maintenance of the site and deactivation, among other concerns.
There is also a warning for hospitals to make sure they can deliver healthcare at the surge site.
“The term ‘surge site’ is used to describe a non-patient care area either inside the walls of the facility or a site immediately adjacent such as a tent, trailer, or other mobile and temporary facility. This document does NOT address the use of alternative care sites in the community or off-campus that may be used for patient screening or for overflow of hospitalized patients. Please contact your state licensing agency and CMS Regional Office for information about your specific licensing and certification requirements,” according to the fact sheet. The fact sheet also includes links to a number of other resources.

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