COVID-19 Hospital Preparedness Assessment Tool



COVID-19 Hospital Preparedness Assessment ToolBackgroundThis checklist has been developed to support Victorian hospitals (metropolitan, rural and private) to plan their response to COVID-19 and is based on and should be read in conjunction with, your business continuity plans and pandemic plans. The tool is intended as a checklist of topic areas that each hospital service should be considering. The checklist is not intended to be a comprehensive set of instructions.Ongoing work may be required to adapt the referenced resources to suite the individual setting(s). In some cases, new resources may need to be developed in conjunction with Department of Health and Human Services (DHHS) and other agencies. This checklist will be continually revised and refined as the situation progresses.The COVID-19 checklist has been adapted from the World Health Organisation (WHO) Hospital emergency response checklist; an all hazards tool for hospital administrators and emergency managers.IndexKey component 1: Command and ControlKey component 2: Communication Key component 3: Safety and SecurityKey component 4: Initial AssessmentKey component 5: Surge CapacityKey component 6: Continuity of Essential ServicesKey component 7: Human ResourcesKey component 8: Logistics and Supply ManagementKey component 9: Post Disaster RecoveryKey component 1: Command and ControlA well-functioning command-and-control system is essential for effective hospital emergency management operations (Figure 1).Figure 1. Organisational structure of the incident management systemRecommended actionPending reviewIn progressCompletedActivate the hospital incident command group (ICG) or establish an ad hoc ICG to direct and supervise hospital-based emergency management operations (see Box 1).1.2 Designate a hospital command centre i.e. a specific location prepared to convene and coordinate hospital-wide emergency response activities and equipped with effective means of communication.1.3 Designate prospective replacements for directors and focal points to guarantee continuity of the command-and-control structure.1.4 Consult core COVID-19 internal and external documents and websites (see recommended resources).1.5 Review organisational protocols on; outbreak management, identifying and isolating patients, aerosol-generating procedures, PPE, contact tracking log, Review processes for infection risk assessment on admission or presentation, number of isolation beds/rooms and explore cohorting possibilities.1.6 Implement or develop job action sheets that briefly list the essential qualifications, duties and resources required of ICG members, hospital managers and staff for emergency-response activities 1.7 Ensure all ICG members have been adequately trained on the structure and functions of the incident command system (ICS) and that other hospital staff and community networks are aware of their roles within the ICS (see COVID-19 tabletop scenario tool).-63571120Box 1. Ad hoc hospital incident command groupIf NO mechanism is in place for coordinated hospital incident management (i.e. a hospital ICG), the hospital director should promptly convene a meeting with all heads of services in order to create an ad hoc ICG. An ICG is essential for effective development and management of hospital-based systems and procedures required for successful emergency response.When organising a hospital incident command group, consider including representatives from the following services (where available):Hospital administrationInfection controlCommunicationsSecurityEngineering, infrastructure and maintenanceNursing administrationLaboratoryHuman resourcesOccupational health and safetyPharmacyLaundry, cleaning and waste managementIn large services the addition of medical staff working, for example, in emergency medicine, intensive care, infectious disease, internal medicine, paediatrics or for rural services a local general practitioner should be represented.It would be important for rural and regional health services to consider how they could respond and support each other.00Box 1. Ad hoc hospital incident command groupIf NO mechanism is in place for coordinated hospital incident management (i.e. a hospital ICG), the hospital director should promptly convene a meeting with all heads of services in order to create an ad hoc ICG. An ICG is essential for effective development and management of hospital-based systems and procedures required for successful emergency response.When organising a hospital incident command group, consider including representatives from the following services (where available):Hospital administrationInfection controlCommunicationsSecurityEngineering, infrastructure and maintenanceNursing administrationLaboratoryHuman resourcesOccupational health and safetyPharmacyLaundry, cleaning and waste managementIn large services the addition of medical staff working, for example, in emergency medicine, intensive care, infectious disease, internal medicine, paediatrics or for rural services a local general practitioner should be represented.It would be important for rural and regional health services to consider how they could respond and support each other.Recommended resourcesDHHS guidance for health services and general practitioners – COVID-19 < DHS: Coronavirus (COVID-19) resources for health professionals, including pathology providers and healthcare managers <: Coronavirus Disease 2019 (COVID-19) Hospital Preparedness Assessment Tool <: Checklist for hospitals preparing for the reception and care of coronavirus 2019 (COVID-19) patients < procedures for infectious diseases <; or call: 1300 651160Australian Infection Prevention and Control guidelines < health emergency response arrangement < Pandemic preparedness scenario tool provided with this document key component 2: CommunicationClear, accurate and timely communication is necessary to ensure informed decision-making, effective collaboration and cooperation, and public awareness and trust. Consider taking the following actions.Recommended actionPending reviewIn progressCompleted2.1 Appoint a public information spokesperson to coordinate hospital communication with the public, the media and health authorities.2.2 Designate a space for press conferences (outside the immediate proximity of the emergency department/urgent care centre/fever clinic, triage/waiting areas and the command centre).2.3 Draft brief messages for targeted audiences (i.e. patients, staff, public) in preparation for the most likely scenarios. For rural services consider linking with regional centres for standard messaging resources.2.4 Signs are posted at all entrances (including triage areas) with instructions to individuals with symptoms of respiratory infection to put on a face mask and if recent travel history to an infected area to notify triage or nursing staff. Also consider posters asking visitors not to come if they are unwell.2.5 Ensure that all communications to the public, media, staff (in general) and health authorities are approved by the incident commander or ICG. 2.6 Establish streamlined mechanisms of information exchange between hospital administration, department/unit heads and facility staff. 2.7 Brief hospital staff on their roles and responsibilities within the incident action plan.2.8 Establish mechanisms for the appropriate and timely collection, processing and reporting of information to supervisory stakeholders (i.e. the department of health and human services) and through them to neighbouring hospitals, Ambulance Victoria, private practitioners, primary care networks and local government.2.9 Ensure all decisions related to patient prioritisation (adapted admission and discharge criteria, triage methods, infection prevention and control measures) are communicated to all relevant staff and stakeholders.2.10 Ensure the availability of reliable and sustainable primary and back-up communication systems (i.e. Satellite phones, mobile devices, landlines, internet connections, pagers, two-way radios, unlisted numbers), as well as access to an updated contact list.2.11 Ensure your health services has updated their Hospital Single Contact Point (HSCP) details. These details are used for health sector First Wave notifications. Health services can directly access the portal to update their details via the DHHS Portal <patientportal.dhhs..au>Recommended resourcesCOVID-19 related posters: < for confirmed and suspected cases, close and casual contacts: < Health Officer Alert: < component 3: Safety and securityWell-developed safety and security procedures are essential for the maintenance of hospital functions and for incident response operations during a pandemic. Consider taking the following actions.Recommended actionPending reviewIn progressCompleted3.1 Assess security risks and assign responsibility to the appropriate team or individuals. 3.2 Prioritise security needs in collaboration with the hospital ICG. Identify areas where increased vulnerability is anticipated (i.e. entry/exits, essential supplies such as food/water, and pharmacy and PPE stockpiles).3.3 Ensure the early control of facility access point(s), triage site(s) and other areas of patient flow, traffic and parking. Limit visitor access as appropriate.3.4 Establish a reliable mode of identifying authorised hospital personnel, patients and visitors.3.5 Ensure that security measures required for safe and efficient hospital evacuation are clearly defined.3.6 Ensure the rules of engagement in crowd control are clearly defined.3.7 Solicit frequent input from the hospital security team with a view to identifying potential safety and security challenges and constraints, including gaps in the management of hazardous materials and the prevention and control of infection. 3.8 Identify information security risks. Implement procedures to ensure the secure collection, storage and reporting of confidential information.3.9 Define the threshold and procedures for integrating local police.Key component 4: Initial assessmentMaintaining patient triage operations, based on a well-functioning pandemic assess and stream protocol, is essential for the appropriate organisation of patient care. Consider taking the following actions.Recommended actionPending reviewIn progressCompleted4.1 Designate an experienced triage officer to oversee all assessment and streaming operations (i.e. an emergency physician senior emergency nurse in a supervisory position, urgent centre nurse).4.2 Ensure that areas for receiving patients, as well as waiting areas, are effectively covered, secure from potential environmental hazards and provided with adequate workspace, lighting and access to auxiliary power.4.3 Ensure the assessment area has good access to essential personnel, medical supplies and key care services or establish links to these services if they are not on site (i.e. the emergency department, operative suites, intensive care unit, pathology services)4.4 Ensure that the entrance and exit routes to/from the assessment area are clearly identified.4.5 Identify contingency sites for acute respiratory clinic (i.e. fever clinics). A checklist for a fever clinic is currently being considered.4.6 Establish an admission protocol based on severity of illness and hospital capacity that follows accepted principles and guidelines.4.7 Establish a clear method of patient triage identification, ensuring clear segregation of respiratory patients and others i.e. Social distancing.4.8 Identify a mechanism whereby the hospital pandemic response plan can be activated from the emergency department or triage site.4.9 Ensure that adapted protocols on hospital admission, discharge, referral and intensive care access are operational when the disaster plan is activated to facilitate efficient patient processing.4.10 Ensure engineering/infrastructure assessment of all areas with respect to optimising infection prevention (i.e. ventilation)Key Component 5: Surge capacitySurge capacity – defined as the ability of a health service to expand beyond normal capacity to meet increased demand for clinical care – is an important factor for hospital pandemic response and should be addressed early in the planning process. Consider taking the following actions.Recommended actionPending reviewIn progressCompleted5.1 Calculate maximal capacity required for patient admission and care based not only on total number of beds required but also on availability of human and essential resources and the adaptability of facility space for critical care. Consider the length of stay that may require when identifying maximum capacity.5.2 Estimate the increase in demand for hospital services, using available planning assumptions and tools5.3 Identify methods of expanding hospital inpatient capacity (taking physical space, staff, supplies and processes into consideration). This may include support requirements from DHHS to enable this expansion.5.4 Designate care areas for patient overflow and perform engineering and infrastructure assessment with respect to optimising infection prevention requirements (i.e. ventilation).5.5 Increase hospital capacity by outsourcing the care of non-critical patients to appropriate alternative treatment sites (i.e. outpatient departments adapted for in-patient use, home care for low-severity illness, and chronic-care facilities for long-term patients)5.6 Verify the availability of vehicles and resources required for patient transportation. This should include vehicles required by staff for visiting patients at home and at possible alternative treatment sites.5.7 Identify potential gaps in the provision of medical care, with emphasis on critical and emergent surgical care and in rural areas local general practitioner support. Address these gaps in coordination with the authorities and neighbouring and network hospitals.5.8 In coordination with local precincts/regional networks, identify additional sites that may be converted to patient care units and staff accommodation/rest facilities. This could include identify areas outside of intensive care units which could be adapted to care for ventilated patients.5.9 Have the ability to prioritise/cancel nonessential services (i.e. low priority elective surgery, specialist clinics) when necessary.5.10 Adapt hospital admission and discharge criteria and prioritise clinical interventions according to available treatment capacity and demand.5.11 Designate an area for use as a temporary morgue. Ensure the adequate supply of body bags.5.12 Formulate a contingency plan for post-mortem care with the appropriate partners (i.e. funeral parlours and pathologists)Recommended resourcesDHHS Case and contact management guidelines: < Guidance on testing for COVID-19: < College of Emergency Medicine (ACEM) - Guidelines on Management of severe influenza, pandemic influenza and emerging respiratory illnesses in Australasian Emergency Departments (2014): < component 6: continuity of essential servicesA pandemic does not remove the day-to-day requirements for essential medical and surgical services (i.e. emergency care, urgent operations, maternal and childcare, aged care provision) that exists under normal circumstances. The availability of essential services needs to continue in parallel with the activation of a pandemic plan. Consider taking the following action.Recommended actionPending reviewIn progressCompleted6.1 List all hospital services, ranking them in order of priority6.2 Identify and maintain the essential hospital services i.e. those that always need to be available, in any circumstances.6.3 Identify the resources needed to ensure the continuity of essential hospital, aged care and community based services such as dialysis and day chemotherapy, in particular those for the critically ill and other vulnerable groups.6.4 Ensure the existence of a systematic and deployable evacuation plan that seeks to safeguard the continuity of critical care (i.e. access to mechanical ventilation, life-sustaining drugs and oxygen support)6.5 Coordinate with Department of Health and Human Services, neighbouring hospitals and private practitioners on defining the roles and responsibilities of each member of the local health care network to ensure the continuous provision of essential medical services throughout the community. Cohorting of some groups may be required.6.6 Ensure the availability of backup arrangements for essential lifelines, including water, power and oxygen.6.7 Anticipate the impact on hospital supplies of food and water. Take action to ensure the availability of adequate supplies including staffing Consider discussing with local government regarding meals on wheels for alternative treatment sites.6.8 Ensure contingency mechanisms for the collection and disposal of hospital waste 6.9 To ensure proper cleaning and disinfection of environmental surfaces and equipment in patient room.6.10 Facility has a process to ensure shared and non-dedicated equipment is cleaned and disinfected after use according to manufactures instructions.Key componet 7: Human resourcesEffective human resource management is essential to ensure adequate staff capacity and the continuity of operations during any incident that increases the demand for human resources. Consider taking the following actions.Recommended actionPending reviewIn progressCompleted7.1 Update the hospital staff contact list.7.2 Estimate and continuously monitor staff absenteeism.7.3 Establish a clear staff sick-leave policy, including contingencies for ill family members and possibly cancelling planned leave. 7.4 Identify the minimum needs in terms of health-care workers and other hospital staff to ensure the operational sufficiency of a given hospital department/residential aged care.7.5 Establish a contingency plan for the provision of food, water and living space for hospital personnel who are unable to travel home. 7.6 Establish staff re-deployment policies, ensuring surge capacity and flexibility while limiting staff movement between areas. 7.7 Consider alternative staffing models where there is difficulty recruiting staff. Establish processes for rapid employment and emergent credentialing of clinical staff. This could include cross training between disciplines for transdisciplinary roles such as allied health, ENs, health care assistants in low risk tasks such as fever clinic screening and triage/diversion of patients.7.8 Address liability, insurance and temporary licensing issues related to additional staff and volunteers who may be required to work in areas outside the scope of their training or for which they have no licence.7.9 Provide education and job-specific training to healthcare workers regarding COVID-19; signs and symptoms of infection, how to safely collect a specimen, correct personal protective equipment (PPE) use, triage procedures including patient placement, sick leave policies and who COVID-19 cases should be reported.7.10 Consider alternate staffing models to care for more ventilated patients (i.e. team-based models of care, different staffing rations, cross train health-care providers in high-demand services (i.e. emergency, surgical and intensive care units). 7.11 Provide training and exercises in areas of potential increased clinical demand, including emergency and intensive care to ensure adequate staff capacity and competency.7.12 Identify domestic support measures (i.e. travel, childcare, care for ill or disabled family members) to enable staff flexibility for shift reassignment and longer working hours.7.13 Review existing roster patterns are safe and sustainable. 7.14 Ensure the availability of multi-disciplinary psychology support teams that include social workers, counsellors, interpreters and clergy for the families of staff and patients7.15 Ensure that staff are vaccinated with the seasonal influenza vaccine. Consider pneumococcal vaccine for high risk staff/volunteers and those over 65.Recommended resourcesWHO Infection Prevention and Control for COVID-19 online course: <;*Note: Please continue to follow Victoria’s case definition and Australia’s travel advice. Please read the published modules from the WHO Infection Prevention and Control for COVID-19 online course and do not refer to the discussion board for credible information.DHHS: How to put on and fit check a P2 respirator: <: How to put on your PPE: <: How to take off your PPE: < guidance on rational use of PPE for COVID-19: < HYPERLINK "" guide<; key component 8: logistics and supply managementContinuity of the hospital supply and delivery chain is often an underestimated challenge during a pandemic, requiring attentive contingency planning and response. Recommended actionPending reviewIn progressCompleted8.1 Develop and maintain an updated inventory of all equipment, supplies and pharmaceuticals; establish a shortage-alert mechanism8.2 Estimate the consumption of essential supplies (i.e. PPE and handwashing) and pharmaceuticals (i.e. amount used per week) using the most likely disaster scenarios.8.3 Consult with authorities to ensure the continuous provision of essential medications and supplies (i.e. those available from institutional and central stockpiles and through emergency agreements).8.4 Assess the quality of contingency items prior to purchase; request quality certification if available8.5 Establish contingency agreements (i.e. memoranda of understanding) with vendors to ensure the procurement and prompt delivery of equipment, supplies and other resources in times of shortages.8.6 Identify physical space in the hospital for the storage and stockpiling of additional supplies, taking ease of access, security, temperature, ventilation, light exposure, and humidity level into consideration. Ensure an uninterrupted cold chain for essential items requiring refrigeration.8.7 Stockpile essential supplies and pharmaceuticals in accordance with national guidelines. Ensure timely use of stockpiled items to avoid loss due to expiration. 8.8 Define hospital/community pharmacy’s role in providing pharmaceuticals to patients being treated at home or at alternative sites.8.9 Ensure that a mechanism exists for the prompt maintenance and repair of equipment required for essential services (i.e. negative pressure rooms). Postpone all non-essential services when necessary.8.10 Coordinate a contingency transportation strategy with prehospital networks and transportation services to ensure continuous patient transferral.Recommended resourcesWHO guidance on rational use of PPE for COVID-19: < component 9: Post disaster recoveryRecommended actionPending reviewIn progressCompleted9.1 Appoint a pandemic recovery officer responsible for overseeing hospital recovery operations.9.2 Determine essential criteria and processes for incident demobilisation and system recovery9.3 Organise a team of hospital staff to carry out a post-action hospital inventory assessment; team members should include staff familiar with the location and inventory of equipment and supplies. Consider including equipment vendors to assess the status of sophisticated equipment that may need to be repaired or replaced.9.4 Provide a post-action report to hospital administration, emergency managers and appropriate stakeholders that includes an incident summary, a response assessment and an expense report.9.5 Organise professionally conducted debriefing for staff to assist with coping and recovery, provide access to mental health resources and improve work performance.9.6 Establish a post-disaster employee recovery assistance program according to staff needs, including, for example, counselling and family support services.9.7 Show appropriate recognition of the services provided by staff, volunteers, external personnel and donors during disaster response and recovery.ReferencesHospital emergency response checklist. An all hazards tool for hospital administrators and emergency managers. World Health Organisation 2011 accessed March 2020 <; ................
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