SOUTH WEST LHIN MODERATE SURGE ACTION PLAN

Transcription

1 Surge Capacity Management Plan SOUTH WEST LHIN MODERATE SURGE ACTION PLAN January 17, 2011

2 Introduction This document is intended to provide the South West Local Health Integration Network (LHIN), and the ministry with a detailed description of the South West LHIN s response to a moderate surge. This Plan will be shared with the LHIN/ MMC table to increase awareness of our LHIN response plans across the province. In addition it will be used to provide an opportunity to increase awareness of the approach being taken locally, and across the province to facilitate the surge response. Background Building on the successes of a LHIN Demonstration Project in the Champlain LHIN, on January 19, 2009, the Minister of Health and Long-Term Care announced a provincial roll-out of Ontario s Surge Capacity Management Program. The Surge Capacity Management Program will give healthcare providers and administrators the tools they need to better handle increases in volume of patients who are in life-threatening situations. When fully implemented by 2010, the plan will ensure integrated communications plans, streamlined use of information technology and predetermined plans for human resources, physical space and equipment. Strategy for Surge Capacity Planning Surge Capacity Planning involves planning for situations where critical care demand exceeds available capacity. The planning starts with individual organizations, but is expandable and scalable to address increasing demands from higher patient volumes. A pandemic plan involves addressing a large scale infectious event, and is a specific example of major surge capacity response plan. However the plan outlined in this document will prepare regions for any cause of surge and any type of surge. The different levels of surge are described below. Minor Surge: An acute increase in demand for Critical Care services- up to 15% beyond the normal capacity, which is localized to an individual hospital. Moderate Surge: A larger increase in demand for critical services that impacts on a LHIN/ Region. Major Surge: An unusually high increase in demand that overwhelms the health care resources of individual hospital(s) and region(s). Individual hospitals have been working on using common elements and principles to manage minor surges. This common approach will facilitate each level of surge planning to become a rehearsal for the next. Minor surge responses become the rehearsals for large scale responses that are required for moderate and major surges. This escalation using a standardized approach for preparation becomes the key success factor in managing surge events. 2 P a g e

3 A Moderate Surge Capacity Management Plan Each LHIN team received an action plan with the following objectives to develop their moderate surge plan. For a complete description of the objectives refer to LHIN Action Plan document. Please complete section A below to provide an overview of the planning activity in your LHIN. Objective 1: Establishing a Management and Communication Structure to Coordinate Future Events Objective 2: Perform an environmental scan of the LHIN to identify and mitigate risks Objective 3: Identify the essential health services to ensure sustainability of the Critical Care Service in the LHIN Objective 1: Establishing a Management and Communication Structure for LHIN level- Moderate Surge Response During your planning phase did you form a team to develop your plan? Did you include membership from each of the partner hospitals in the LHIN? If you would like the Secretariat to review the Terms of Reference for this group you may append them to the plan Did the team develop an inter-hospital decision and communication algorithm as per the Critical Care Surge Management Plan? Objective 2: Perform an environmental scan of the LHIN to identify and mitigate risks YES YES YES NO NO NO Did you perform an environmental scan of your LHIN to identify existing risks? During your planning did you form mitigation strategies for the risks identified? If you would like the Secretariat to review the Risk Assessment for this group you may append them to the plan YES YES NO NO 3 P a g e

4 Objective 3: Identify the essential health services to ensure sustainability of the Critical Care Service in the LHIN During your planning have you developed a plan that will take into consideration the following elements in a moderate surge? Inter-hospital communications related to timely access to critical health services A coordinated approach to sharing resources De-escalating elective services Service consolidation within LHIN boundaries Identification of essential services that that must continue regardless of circumstance Does the moderate surge plan have pre-determined timeline for evaluation Have you considered the following in your planning: Creating binding repatriation guidelines or policies Involving Community Care Access Centers and Social Work Involving local EMS and ORNGE transport in your planning YES YES YES YES YES YES YES YES YES NO NO NO NO NO NO X NO NO X NO Have you identified a trigger system that will allow for escalation to other LHIN s or a provincial response YES NO Section B Summary of LHIN Surge Capacity Plan Section B is intended to be a detailed description on how each of the 5 elements of the surge capacity management response plan will be managed at the LHIN level during a moderate surge. The first row in each section describes the planning assumptions which were provided to you in the previous planning assumptions document. You do not have to add anything to this section. The second row is where you fill in the details of your plan. Please review the planning assumptions before completing plan details in Section B. LHIN Plan can be summarized in bullet points. 4 P a g e

5 Section B 1. Management CCS Planning Assumptions Each hospital has implemented a surge capacity plan as outlined in the Surge Capacity Management toolkit and is able to meet the accountabilities as outlined in the Ontario Plan of Action document. During a response At the local hospital a tiered response will occur prior to escalation to moderate surge response (Refer to Moderate Surge Response Guide) The hospital will have deployed their minor surge plans. Once the 5 elements of surge capacity management have been considered, and if hospitals resources have been flexed to 15% above normal critical care capacity, but the ongoing demand exceeds the required resources, a moderate surge response will be triggered. An important assumption regarding specialty services: If a hospital does not have the service required by the patient, or patient safety is likely to be compromised, the index hospital can escalate to moderate surge to ensure patient safety. CCIS will be utilized to capture current capacity through the bed availability tool Each hospital will manage internal communications regarding internal surge planning and plan execution. As the hospital escalates to a moderate surge response, the hospital CEO or delegate from Senior Team along with attending physician of index hospital will notify CritiCall of the need for escalation and CritiCall will facilitate a call with LHIN Lead and LHIN CEO/Delegate- with next steps to be determined by LHIN leadership. (Refer to Moderate Surge Response Guide) If after initial discussion further escalation is required each potential receiving LHIN hospital will be notified by CritiCall to attend a teleconference. The notification will be made to Switchboard who will notify the most appropriate senior management person, who will then notify the Critical Care leadership of that hospital. The Critical Care LHIN Lead and LHIN CEO will lead the moderate surge response. LHIN Checklist and communication plans are in place to support the response. 5 P a g e

6 LHIN Plan: In this section please identify strategies to address management processes that have been established within the LHIN. Please see the South West LHIN Moderate Surge Decision & Communications Algorithm that is attached (Appendix A) Each hospital will identify key leadership and contact(s) to provide management during a moderate surge Please see South West LHIN Moderate Surge Planning Task Team Terms of Reference (Appendix B) These will consist of a clinical lead (clinical lead will be familiar with the ICU environment at that institution and be able to accept patients), as well as, ICU nursing coordinator/manager) and an administrative lead for moderate surge (administrative lead will be able to make institution wide changes to accommodate for critical care surge). 2. Human Resources CCS Planning As part of Minor surge planning hospitals will have developed plans for mobilizing staff from other areas Assumptions within a hospital to be available to work in Critical Care areas as necessary. Hospitals will consider alternative staffing and escalate to alterative staffing models as required. Hospitals will modify internal staffing patterns, as appropriate. Organized labour will be included in the hospital predetermined plans for alternative staffing models. If the Moderate Surge event should be an infectious process, staff will be supplied with proper PPE. Acute care hospitals should have staffing plans developed and be prepared to receive over-flow patients from other LHIN hospitals. LHIN Plan: In this section please identify strategies to address Human Resource plans across the LHIN NB: As Human Resources can be challenging to plan due to the limitations from multiple elements ranging from available resources, variances of skills and existing organized labour contractual agreements. Please identify existing strategies or recommendations on further develop this strategy. All hospitals in the South West LHIN will have plans for crtical care staffing up to 115% of usual capacity In the event of a moderate surge, hospitals in the South West LHIN will have plans to deal with capacity greater than 115% (Refer to Appendix C SW LHIN Critical Care Services Inventory for moderate surge bed capacity and location) In the event of a pandemic, all hospitals in the South West LHIN capable of surging of 150% will have plans to deal with up to 150% of critical care capacity 6 P a g e

7 Support through telephone consultation from medical staff at London Health Sciences Center to other centers within the LIHN may help reduce the demand for transfer (ICU physician on-call pilot project pending). After discussion and consideration, multiple challenges (e.g. variable levels of training, institutional capabilities and distances) were identified that would prohibit sharing of human resources between the institutions within the LHIN. At present, there are no plans to share human resources. 3. Equipment CCS Planning Assumptions Each hospital will have taken measures to ensure there is an adequate four week supply of equipment and supplies to sustain their critical care units as functional Each hospital will ensure current supply of ventilators are maintained and ensure the ventilator inventory is keep current Each hospital will verify the functionality of all ventilators in storage and identify which ventilators from storage can be utilized in a time where there is increasing demand. IF a hospital should near their ventilator capacity the following steps will be actioned All organizational ventilator capacity would have been considered Hospitals will notify CritiCall who will in response locate the Critical Care LHIN leader and teleconference the Lead with the Index hospital If a predetermined plan exists for ventilator sharing in the LHIN or across hospitals this plan will be actioned. (Refer to Ontario Ventilator Stockpile Guidance Document) o The LHIN Critical Care Lead will determine if equipment can be made available to the hospital in need by other institutions within the LHIN. o Hospitals within the LHIN should be prepared to provide mechanical ventilators to the point they are limited to 2 high functioning units o Equipment will be repatriated to the lending institution as a priority When all local equipment measures are exhausted the Critical Care Lead will notify the Critical Care Secretariat for a ventilator equipment options. 7 P a g e

8 LHIN Plan: In this section please identify strategies to address equipment shortages or sharing strategies across the LHIN Hospitals within the LHIN agree on the importance of sharing resources in the event of a surge. This sharing will take precedence over routine scheduled procedures that require Critical Care resources in the event of a moderate surge. In the event that the ventilator stockpile at London Health Sciences Centre needs to be accessed, the process defined by the Critical Care Secretariat will be followed (Refer to Ontario Ventilator Stockpile Guidance Document) 4. Physical Plant CCS Planning Assumptions LHIN Plan: Each hospital will take the appropriate steps to manage their minor surge plans including consideration for alternative physical space. Hospitals within the LHIN will be prepared to accept patients from other centers to ensure timely access to care is gained for Critically ill patients NB: Critical Care Secretariat recognizes the limitations in planning for physical space as it also requires human resources and equipment. If you have developed specific strategies around physical space please provide details or indicate your assumptions around physical space. All institutions within the LHIN will identify the necessary spaces to accommodate critically ill patients to 115% of critical care capacity In the event of a moderate surge, all institutions within the LHIN will identify the necessary spaces to accommodate critically ill patients to capacity greater than 115% (Refer to Appendix C SW LHIN Critical Care Services Inventory for moderate surge bed capacity) For pandemics, all institutions within the LHIN capable of surging up to 150% will identify the necessary spaces to accommodate critically ill patients to 150% of critical care capacity (need to identify institutions that can/cannot accommodate) 8 P a g e

9 5. Processes to Address Surges The information in this section is intended to detail the plan that your LHIN has established for responding to a Moderate Surge. Please ensure that you have included details on how you will carry out your moderate surge plan for EACH of the sections indicated below (NOTE: a separate table has been created for each section). Additional sections should be added to address specific nuances that relate specifically to your LHIN Planning Assumptions for Section 5: CCS Planning During a surge response Assumptions At the local hospital a tiered response will occur prior to escalation to moderate surge response. The hospital will have deployed their minor surge plans. Once the 5 elements of surge capacity management have been considered, and if hospitals resources have been flexed to 15% above normal critical care capacity, but the ongoing demand exceeds the required resources, a moderate surge response will be triggered. An important assumption regarding specialty services: If a hospital does not have the service required by the patient, or patient safety is likely to be compromised, the index hospital can escalate to moderate surge to ensure patient safety. CCIS will be utilized to capture current capacity through the bed availability tool Each hospital will manage internal communications regarding internal surge planning and plan execution. Hospitals will follow the outlined provincial notification plan and provide detailed information regarding the index event All remaining hospitals will provide information on capacity and capability The LHIN is collaboration with their hospitals is developing strategies and process to manage the following moderate surge processes Moderate Surge Processes A. Inter-hospital Communications B. Resource Sharing C. De-escalation of elective services D. Service Consolidation within LHIN boundaries E. Identification of essential services that that must continue regardless of circumstance 9 P a g e

10 F. Patient transfer and repatriation G. Engaging Community Care Access Centre and Social Work H. Transportation 5A. Inter-hospital Communications LHIN Plan: In this section please identify: A. Details or processes that have been established outside of the Provincial notification process and response plan, which address inter-hospital communication. B. Details regarding the LHIN s contingency plan/process. For example: if the LHIN CEO is not available who is the designate from the LHIN office. Each hospital has designated administrative and clinical contacts in the case of moderate surge (South West LHIN Moderate Surge Planning Task Team Terms of Reference, Appendix B) Frequent reporting cycles and teleconferences (determined at time of moderate surge trigger event) with these contacts will occur at agreed intervals (1,2,4, 6 or 8 hours) during a moderate surge A designated teleconference line will be set up to facilitative daily conference calls with key stakeholders during moderate surge. 5B. Resource Sharing LHIN Plan: In this section please identify the LHIN plan/process for resources sharing across the LHIN prior to escalation to other LHIN s or the Province. Resources are identified as equipment and supplies. Critical care resources will be utilized fully before escalation to other LHIN s or the Province. The majority of Level 3 capacity and access to speciality services is at London Health Sciences Centre (University Hospital and Victoria Hospital). By shifting Level 2 patients to other institutions in the region, the Level 3 capacity at LHSC can be better utilized. Please see South West LHIN Critical Care Services Inventory (Appendix C) and Geographic Distribution of South West LHIN Critical Care Services (Appendix D). 10 P a g e

11 5C. De-escalation of Services across the LHIN LHIN Plan: In this section please identify the LHIN plan/process to de-escalate services across the LHIN during a moderate surge response. In the event of a moderate surge level all scheduled cases (Priority B and C see below for definitions of priority levels) requiring Critical Care will be cancelled. Only Priority A Cases will proceed. Priority A - Emergent cases: Patients who are deemed critical, whose condition is immediately life threatening. Their immediate need is greatest and they must be treated Priority B - Urgent cases: Patients who are deemed urgent and who need service within 14 days. It may be possible to defer these services for a few days, but not for the length of a moderate surge. Physicians will determine that these patients are not put at undue risk. If their situation changes they will be moved to priority A. Priority C - Elective cases: Patients whose condition is deemed non-life threatening and for whom services can be deferred until the end of the moderate surge. 5D. Service Consolidation with LHIN boundaries LHIN Plan: In this section please identify the LHIN plan/process to consolidate services during a moderate surge response Redistribution of critically ill patients requiring different levels of critical care may occur depending on the critical care needs of the patients in the ICU and those necessitating moderate surge. (Refer to Moderate Surge Response Guide) 5E.Identification of essential services that that must continue regardless of circumstance LHIN Plan: In this section please identify the LHIN s plan/process to identify essential services within the LHIN and the plan to ensure that they continue to are offered in during a moderate surge Only Priority A cases as delineated above will continue in the midst of a moderate surge. 11 P a g e

12 5F. Patient Transfer and Repatriation LHIN Plan: In times of surge patient transfer and repatriation has the ability to ensure sustainability of the critical care services. Please provide information the development of LHIN wide repatriation agreements during a response time. If you have experienced limitations regarding this planning please share the details here. Transfer/repatriation agreements between the institutions within the LHIN have not been completed at this time. During a surge response the Critical Care LHIN leader will assess available resources and resource distribution to ensure sustainability of critical care services. 5G. Engaging CCAC and Social Work LHIN Plan: In managing a surge response at time we must include other members of the health care team to ensure our plan is achievable. Please provide details on engaging CCAC and Social work within your planning process. The section below will give you an opportunity to address transport. CCAC and Social Work will be involved in the discussions regarding moderate surge to provide support to patients/families. 5H. Transportation LHIN Plan: Transportation is vital to all planning processes please provide details on LHIN level planning around transportation. Transportation continues to be a challenge across the South West LHIN. Transportation providers are spread throughout the LHIN and the provision of such services varies across the geography. Extensive planning and a comprehensive engagement process to identify strategies for transportation during a moderate surge is yet to be completed and requires an extensive project planning. Attached is a high-level transportation flowchart (Appendix E) that can be used as a reference but is not tailored to the processes that individual hospitals follow to arrange transportation of their patients. 12 P a g e

13 Appendices Please provide a list of appendices that you have included in your plan and attach them with this document. Appendix A: South West LHIN Moderate Surge Decision & Communications Algorithm Appendix B: South West LHIN Moderate Surge Planning Task Team Terms of Reference Appendix C: South West LHIN Critical Care Services Inventory Appendix D: Geographic Distribution of South West LHIN Critical Care Services Appendix E: Moderate Surge Transport Flowchart 13 P a g e

14 Appendix A: South West LHIN Moderate Surge Decision & Communications Algorithm

15 Roles & Responsibilities Moderate Surge Decision & Communication Algorithm Phases Identify Moderate Surge Diagnose Situation Deliver Critical Care Secretariat Criticall notifies CC Secretariat Julie Trpkovski, Manager CC Secrtariate, and/or Bernard Lawless, Provincial Lead, CC & Tramua, MOHLTC Update CC Secretariat of Status of Moderate Surge Legend Criticall South West LHIN Criticall Number Sets up of teleconference with LHIN CEO, Critical Care LHIN Lead, Index Hospital CEO & Physician LHIN CEO/ Delegate on Teleconference LHIN Critical Care Lead/Delegate on Teleconference LHIN CEO & LHIN CC Lead activate Moderate Surge response LHIN Moderate Surge Checklist Determine Resource Requirements: Equipment Space Human Resources Supplies LHIN CEO/ Delegate on Teleconference LHIN CC Lead/ Delegate on Teleconference Is transport for patient or equipment requried? Ornge &/or EMS on Teleconference Frequency of reporting cycle determined (1, 2, 4, 6 or 8 hour updates) Institute LHIN Level alternative measures for escalation or services and/or de-escalation of services LHIN CC Lead activates process to transport vents from LHSC (18 vents available) Review of event and resources required Confirmation of available resources from other LHIN Hospitals CC Network Moderate Surge Contact List Bed Availability Tool Reevaluate until situation is resolved or escalation is required Set up daily teleconference line with key stakeholders until moderate surge resolved Patient(s) &/ or equipment transferred according to Moderate Surge Transport Flow Chart Process Decision Document Predefined Process Index Hospital Index Hospital Physician triggers Moderate Surge Response Hospital CEO/ Delegate is notified of Moderate Surge and contact Criticall Is patient Care Compormised? Is there > 115% occupancy? Hospital CEO on Teleconference Index Hospital Physician on Teleconference What is the situation? What actions have been taken to mitigate surge? What actions are requried for moderate surge? What resources are required? Minor Surge Plan Services Inventory Does the vent stockpile need to be accessed? Sets up of teleconference with LHIN CEO, CCLHIN Lead, Index Hospital CEO & Physician, Partner/Receiving Hospital Physician & One Number Staff/Bed Manager/Nurse Coordinator, Ornge &/or EMS Index Hospital CEO on Teleconference Index Physician and One Number Staff/Bed Manager/Nurse Coordinator on Teleconference Institute hospital level alternative measures for escalation or services and/ or deescalation of services Index Hospital contacts CCAC &/ or Social Work for patient/family support Update Bed availability Index Hospital prepares patient for transfer Patient Transfer forms and chart Patient Transferred Terminator Partner/Receiving Hospital Partner/ Receiving Physician(s) and One Number Staff/ Bed Manager/ Nurse Coordinator (s) on Teleconference Update Bed availability Partner/Receiving Hospital (s) prepares for arrival of patient Patient Received Last revised April 15, 2010

16 Appendix B: South West LHIN Moderate Surge Planning Task Team Terms of Reference

17 Moderate Surge Planning Task Team Terms of Reference Background Building on the successes of a LHIN Demonstration Project in the Champlain LHIN, on January 19, 2009, the Minister of Health and Long-Term Care announced a provincial roll-out of Ontario s Surge Capacity Management Program. The plan includes three levels of surge planning: Minor Surge: An acute increase in demand for Critical Care services- up to 15% beyond the normal capacity, which is localized to an individual hospital. Moderate Surge: A larger increase in demand for critical services that impacts on a LHIN/ Region. Major Surge: An unusually high increase in demand that overwhelms the health care resources of individual hospital(s) and region(s). Introduction Starting in March 2009 Hospitals with in the South West LHIN were engaged to develop minor surge plans to ensure health service providers and administrators had plans in place to handle increases in the volume of patients who are in life-threatening situations up to 115% of their capacity. Hospital Minor Surge Capacity Plans included integrated communications plans, streamlined use of information technology and predetermined plans for human resources, physical space and equipment. We are now at the point where the MOHLTC Critical Care Secretariat, the South West LHIN and health service providers are moving into Moderate Surge planning to develop processes and plans that will be enacted in the event that a Moderate Surge Response is triggered in the South West LHIN. Definition: A moderate surge is defined as an increase in demand for critical care services greater than 115% of hospital intensive care unit bed capacity (for all critical care areas), or when patient safety is compromised. Planning Process The aim of developing a moderate surge plan is to sustain critical care services when demand exceeds capacity and/or capability of the hospital and regional resources are required. It therefore requires the development of an organized system-level approach for all hospitals within our LHIN. Last Revised June 6, 2010

18 In order to move forward with Moderate Surge Planning at a LHIN level a planning task team has been convened to progress with this important work. Volunteers from the Critical Care Network have identified delegates from individual hospitals to come forward to be a part of the planning task team. Purpose: The purpose of the planning task team is to develop a standardized LHIN-wide, system level protocol to govern a moderate surge response that ensures access to critical care services, human resources, equipment and physical space in the event where a hospital(s) experience a moderate surge in critical care services. Goal: The goal of the planning task team is to develop a uniform protocol to streamline interaction and communication between hospitals, physicians, managers/delegates, administration and the South West LHIN to manage inter-hospital communications, resource sharing, de-escalation of elective services, service consolidation, identification of essential services & processes, patient transfer and repatriation, coordination with Community Care Access Centre (CCAC), Social Work and transportation. Membership Moderate Surge Planning Task Team Members: LHIN Dr. Michael Sharpe, Critical Care LHIN Lead Carrie Jeffreys, ED/Critical Care Project Coordinator Alexandra Hospital: michael.sharpe@lhsc.on.ca carrie.jeffreys@lhins.on.ca Lisa Gardner lisa.gardner@ah.tvh.ca South West Community Care Access Centre Sherry Fletcher sherry.fletcher@sw.ccac-ont.ca Alexandra Marine and General Hospital: Paul Black, Clinical Leader Mary Mole, Quality and Patient Safety Grey Bruce Health Services: paul.black@amgh.ca mary.mole@amgh.ca x x Jane Wheildon jwheildon@gbhs.on.ca x

19 Hanover and District Hospital: Joanne MacKinnon Huron Perth Healthcare Alliance: Jacquie Martin Listowel & Wingham Hospital Alliance: Ray McNichol London Health Sciences Centre: Catharine Glover Judy Kojlak Pat Merrifield Dawna Van Boxmeer Middlesex Hospital Alliance: TBA South Bruce Grey Health Centre: x x x Kate Kincaid kkincaid@sbghc.on.ca x.302 St. Thomas-Elgin General Hospital: Christine Kirkpatrick Brenda Lambert Tillsonburg District Memorial Hospital: Julie Ellery Woodstock General Hospital: Randy Hicks Diana Eby ckirkpat@stegh.on.ca blambert@stegh.on.ca Julie.Ellery@tdmh.on.ca rhicks@wgh.on.ca deby@wgh.on.ca x Additional members may join as the work progresses. 3

20 Operational Responsibilities The Moderate Surge Planning Task Team will be called into an operational role when a hospital site/alliance has entered into a moderate surge by the definition listed above to: Monitor and ensure implementation of the Moderate Surge Plan to establish communication at a LHIN-wide, systems level to support a critical care system of care Process to operationalize the Critical Care Moderate Surge Plan : o Once a hospital site/alliance meets the criteria for a moderate surge, an operational meeting of the task team will be called by the LHIN Lead, via a teleconference o At that meeting, the LHIN Lead will confirm the need to operationalize the plan, and advise the LHIN CEO of the need to implement the LHIN Critical Care Moderate Surge Plan. The LHIN CEO has accountability to implement the plan, and would ask the Critical Care LHIN Lead to lead the implementation o The LHIN lead will also notify the Critical Care Secretariat of the moderate surge implementation Term Throughout the Moderate Surge planning process and once the plan is finalized and signed off by the CEO/CCAC Leadership Forum. The membership will also be called upon during a moderate surge event until the moderate surge capacity has been resolved. Accountability The task group is advisory to Michael Barrett, South West LHIN CEO, the Critical Care Secretariat and the membership of the LHIN CEO/CCAC Leadership Forum. 4

21 Appendix C: South West LHIN Critical Care Services Inventory

22 Hospital Size Total # of Acute Care Beds Total # of Critical Care Beds # of Level 3 ICU Beds # of Level 2 ICU Beds Total # of Vent capable beds Bi - pap capable beds (Yes/No) # of Minor Surge Beds Location of Minor Surge Beds Additional Resource Requirements for Minor Surge (HHR & Equipment) # of Additional Beds for Moderate Surge # of vents required to make additional beds vent capable # of vents required from vent stockpile to make additional beds vent capable Location of Moderate Surge Beds Additional Resource Requirements for Moderate Surge (HHR & Equipment) Physician Specialists Single Site Hospitals Hanover and District Hospital Very small hospital (primary care) Grey Bruce Health Services GBHS - Markdale Very small hospital (primary care) GBHS - Meaford Very small hospital (primary care) GBHS - Very small Southampton hospital (primary care) GBHS - Wiarton Very small GBHS Lion s Head hospital (primary care) Very, very small primary care hospital SOUTH WEST LHIN CRITICAL CARE SERVICES INVENTORY (last update: January 13, 2010) YES NO NA NA NA NA NA NA NA NA NO NA NA NA NA NA NA NA NA NO NA NA NA NA NA NA NA NA NO NA NA NA NA NA NA NA NA NO NA NA NA NA NA NA NA NA NORTH

23 Hospital Size Total # of Acute Care Beds Total # of Critical Care Beds # of Level 3 ICU Beds # of Level 2 ICU Beds Total # of Vent capable beds Bi - pap capable beds (Yes/No) # of Minor Surge Beds Location of Minor Surge Beds Additional Resource Requirements for Minor Surge (HHR & Equipment) # of Additional Beds for Moderate Surge # of vents required to make additional beds vent capable # of vents required from vent stockpile to make additional beds vent capable Location of Moderate Surge Beds Additional Resource Requirements for Moderate Surge (HHR & Equipment) Physician Specialists GBHS Owen Sound Large multi hospital (secondary) South Bruce Grey Health Centre SBGHC - Chesley Very small hospital (primary care) SBGHC - Durham Very small SBGHC - Walkerton hospital (primary care) Very small hospital (primary care) Yes 2 ICU Handled by staff within Critical Care beds -ICU 2 beds - Level 2 unit(ccu location) CCU - have hemodynamic capability Increased physician support, RNs, RRTs, Additional Allied Health support. Ventilators, monitor modules, 1 CCU room monitor reinstall. Supplies 10 beds YES 0 NA NA 0 NA NA NA NA 10 beds YES 0 NA NA 0 NA NA NA NA 25 beds YES 0 NA NA 0 NA NA NA NA Anatomical Pathology Anesthesia Diagnostic radiology Emergency Medicine Endocrinology & Metabolism Gastroenterology General Surgery Respirology Internal Medicine Neurology Obst & Gyne Ophthalmology Orthopedic Surgery Pediatrics Surgery Physical Medicine & Rehab Psychiatry Urology Thoracic Surgery FamilyMed. Gen. Surg

24 Hospital Size Total # of Acute Care Beds Total # of Critical Care Beds # of Level 3 ICU Beds # of Level 2 ICU Beds Total # of Vent capable beds Bi - pap capable beds (Yes/No) # of Minor Surge Beds Location of Minor Surge Beds Additional Resource Requirements for Minor Surge (HHR & Equipment) # of Additional Beds for Moderate Surge # of vents required to make additional beds vent capable # of vents required from vent stockpile to make additional beds vent capable Location of Moderate Surge Beds Additional Resource Requirements for Moderate Surge (HHR & Equipment) Physician Specialists SBGHC - Kincardine Very small hospital (primary care) Single Site Hospitals Alexandra Marine & General Hospital (Goderich) Small hospital (primarysecondary care) Listowel & Wingham Alliance Listowel Memorial Hospital Wingham and District Hospital Very small hospital (primary Very small hospital (primary care) Very small hospital (primary care) 25 beds YES 0 NA NA 0 NA NA NA NA 54 beds (this includes 20 psych beds) Yes 1 or 2 Patient Room Adjacent to ICU Additional RN Telemetry Units 2 19 beds No ICU beds N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 51 Beds NO NA NA NA NA NA 50 Beds NO NA NA NA NA NA Fam.Med. Day Surg. FM/Emergency medicine General Surgery Internal Medicine Ob/gyne Anesthesia Psychiatry FM/Emergency medicine CENTRAL South Huron Hospital Association 0 2 Inpatient area staff called in as required

25 Hospital Size Total # of Acute Care Beds Total # of Critical Care Beds # of Level 3 ICU Beds # of Level 2 ICU Beds Total # of Vent capable beds Bi - pap capable beds (Yes/No) # of Minor Surge Beds Location of Minor Surge Beds Additional Resource Requirements for Minor Surge (HHR & Equipment) # of Additional Beds for Moderate Surge # of vents required to make additional beds vent capable # of vents required from vent stockpile to make additional beds vent capable Location of Moderate Surge Beds Additional Resource Requirements for Moderate Surge (HHR & Equipment) Physician Specialists Huron Perth Healthcare Alliance HPHA - Stratford Large multi hospital (secondary) Stroke Referral Center HPHA Clinton Public Very small hospital (primary care) HPHA - Seaforth Very small hospital (primary care) HPHA St. Marys Very small Single Site Hospitals Alexandra Hospital (Ingersoll) hospital (primary care) Small hospital (primary) E1S= 21 E3E= 32 E2E=10 E1E= 15 E2S=29 E3S=15 TOTAL = 122 (exclude s CCC beds) Yes 1 (stroke referral bed; needs to be availabl e) ICU Staff LTV portable Vent 1 2 (currently have 2 old vents on site) 0 ICU Staff Ventilators 17 No ICU beds N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 8 No ICU beds N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 15 No ICU beds N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 17 beds bi-pap (3 not) Clinical Decision Unit (CDU) 0 3 None N/A N/A N/A N/A N/A Anatomical pathology Anesthesiology Cardiology Diagnostic radiology Emergency Medicine FM/Emergency Medicine Internal Medicine GP/FPs General Pathology General Surgery Medical Genetics Obst & Gyne Ophthalmology Orthopedic Surgery Anesthesia Internal medicine SOUTH

26 Hospital Size Total # of Acute Care Beds Total # of Critical Care Beds # of Level 3 ICU Beds # of Level 2 ICU Beds Total # of Vent capable beds Bi - pap capable beds (Yes/No) # of Minor Surge Beds Location of Minor Surge Beds Additional Resource Requirements for Minor Surge (HHR & Equipment) # of Additional Beds for Moderate Surge # of vents required to make additional beds vent capable # of vents required from vent stockpile to make additional beds vent capable Location of Moderate Surge Beds Additional Resource Requirements for Moderate Surge (HHR & Equipment) Physician Specialists St. Thomas Elgin General Hospital Tillsonburg District Memorial Hospital Woodstock General Hospital Large Community Hospital (secondary) Small hospital (primary) Large Community Hospital (secondary) 146 beds 6 2 in Yes 1 within unit nil to minimal addition to minor 1 1 surge bed 51 beds ICU May require extra nurse (4 with extra nursing 1 1 resource s) pacu ccu nurse within unit RRT, non certified nursing staff and equipment PACU Nursing nursing staff, RTs, cancel out pt services and elective ORs Pacu (non ventilated) Anatomical Pathology Anesthesia FM/Emergency medicine General Pathology General Surgery Internal Medicine Obst & Gyne Orthopedic Surgery General surgery Internal medicine Anatomical Pathology Anesthesia Diagnostic radiology FM/Emergency medicine Internal Medicine Gastroenterology General Pathology General surgery Laboratory medicine Obs/Gyne Ophthalmology Orthopedic surgery Psychiatry Urology

27 Hospital Size London Health Sciences Center LHSC - University Hospital LHSC - Victoria Hospital St. Joseph s Health Care, London Very large regional hospital (tertiary) Very large regional hospital (tertiary) Total # of Acute Care Beds 341 beds 440 Beds 166 Beds Total # of Critical Care Beds # of Level 3 ICU Beds No ICU beds # of Level 2 ICU Beds 31-see attached table 22* see attached table Total # of Vent capable beds Bi - pap capable beds (Yes/No) # of Minor Surge Beds 40 yes but VH only has 10 machine s 4 Level 3 beds and 4 Level 2 beds Location of Minor Surge Beds 2 in ICU, 4 in PACU Additional Resource Requirements for Minor Surge (HHR & Equipment) HHR if Minor Surge is prolonged Level 3 within CCTC, see HHR for prolonged attached table for minor surge Level 2 # of Additional Beds for Moderate Surge 13 which would put us at 150% capacity. Not confirmed 9 Level 3 beds which would take CCTC to 150% this number has not been fi li d # of vents required to make additional beds vent capable # of vents required from vent stockpile to make additional beds vent capable Location of Moderate Surge Beds Additional Resource Requirements for Moderate Surge (HHR & Equipment) 17 0 PACU Not determined Physician Specialists Cardiology Cardiac Surgery Gen Int Medicine General Surgery Transplant Neurosciences Critical Care Medicine Physician Specialists C ca u o ogy & Allergy Critical Care Medicine Diagnostic Radiology Emergency Medicine gy & Metabolism F.M./Emergency Medicine Gastroenterology N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A To be completed beds within CCTC, 4 beds in PACU Not yet determined Middlesex Hospital Alliance Four Counties Health Services (Newbury) (Middlesex Hospitals Alliance) Very small hospital (primary) 16 Beds No ICU beds N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

28 Hospital Strathroy Middlesex General Hospital (Middlesex Hospitals Alliance) Size Small hospital (primarysecondary) Total # of Acute Care Beds Total # of Critical Care Beds # of Level 3 ICU Beds # of Level 2 ICU Beds Total # of Vent capable beds Bi - pap capable beds (Yes/No) # of Minor Surge Beds Location of Minor Surge Beds Additional Resource Requirements for Minor Surge (HHR & Equipment) # of Additional Beds for Moderate Surge # of vents required to make additional beds vent capable # of vents required from vent stockpile to make additional beds vent capable Location of Moderate Surge Beds Additional Resource Requirements for Moderate Surge (HHR & Equipment) 79 beds N/A N/A N/A N/A N/A N/A N/A N/A N/A Anesthesia Physician Specialists Emergency medicine Diagnostic radiology FM/Emergency medicine General surgery Internal medicine Ophthalmology Orthopedic surgery Otolaryngology Plastic surgery Psychiatry Urology Definition of Level 2 Critical Care Units Capable of providing service to meet the needs of patients who require more detailed observation or intervention including support for a single failed organ system, short-term non-invasive ventilation, post-operative care, patients stepping down from higher levels of care or step ups from lower levels of care. These units provide a level of care that falls between the general ward (Level 1) and a full service Critical care unit (Level 3). Level 2 units do not provide invasive ventilatory support. Please Note: Critical care units that provide invasive mechanical ventilation for a short period (for example 48 hours) but need to transfer those patients who require more long term invasive ventilation to a Level 3 unit are considered Level 2 for the purposes of the service inventory. Definition of Level 3 Critical Care Units Capable of providing the highest level of service to meet the needs of patients who require advanced or prolonged respiratory support, or basic respiratory support together with the support of more than one organ system. This is generally considered a full service Critical Care unit despite the fact some specialized services may not be available (e.g. dialysis). All Level 3 units are capable of invasive ventilatory support. Please Note: For institutions that combine Level 2 and Level 3 type critical care service in one geographic area (i.e. unit), we request that the unit designation reflect the highest level of care provided even if all patients may not be receiving that level of care.

29 Appendix D: Geographic Distribution of South West LHIN Critical Care Services

30 ( South West LHIN Critical Care Services Inventory LIONS HEAD ( WIARTON ( ( ( MEAFORD OWEN SOUND CHESLEY ( MARKDALE KINCARDINE HANOVERDURHAM WALKERTON ( ( ( WINGHAM ( ( GODERICH ( LISTOWEL STRATFORD WOODSTOCK STRATHROY LONDON ( ( INGERSOLL TILLSONBURG ST THOMAS ( NEWBURY Legend Hospitals with Level 3 Unit Capacity ( Hospitals with a Maximum of Level 2 Unit Capacity

31 Appendix E: Moderate Surge Transport Flowchart

32 Moderate Surge Transport Flowchart Critical Patient Requires Transport Unstable & time sensitive What is the patients acuity? Stable* Criticall confirms bed requirement and patients acuity Criticall Coordinates Teleconference for Affected Hospitals Bed Availability Tool Criticall locates bed LHIN CC Lead Index Hospital Physician and Receiving Hospital(s) Physician(s) &/or Nursing Coordinator(s) Bed Coordinators (index hospital and receiving hospital(s)) ORNGE or EMS Criticall contacts ORNGE Level 3 Bed Inventory Level 2 Bed Inventory Action Plan Developed Implementation Plan Developed LHIN Affected partner Daily Conference Call Toll-free Dial-in number: Local dial-in number: Conference ID: ** ORNGE Available ORNGE Transport Criticall Contacts Local EMS EMS Transport * Transportation Principles: - Most stable patient suitable for transport will be transported first - Receiving institution has clinical services required for patient Care - Closest receiving institution with necessary services will be selected ** Moderator PIN - the moderator PIN number is required to initiate the call and is coordinated through the LHIN office Revised as of February