Emergency Department Decompression During Mass Casualty Incidents

Emergency Department Decompression During Mass Casualty Incidents Stacy Gustafson, MA, PMP, MBCP UC Davis Medical Center Joleen Lonigan, RN, MSN, NE-BC UC Davis Medical Center 1

Introduction to UC Davis Health Introduction Video Link to UC Davis Health https://vimeo.com/ Code Triage Definition Code Triage Event: An incident that results in a surge of patients to the Emergency Department (ED) that will create a moderate to severe impact to normal ED and hospital operations. Code Triage Alert optional Code Triage Full Code Triage All Clear 4 2

Code Triage Purpose To provide emergency and disaster activation and response procedures for a surge of Emergency Department patients. Triggers automatic response by departments May occur concurrently with process to activate an external disaster (Code Green) Can support hospital operations until the command center is running (as needed) 5 Code Triage Composition ED Decompression Discharges Reclassification Admissions ED Preparation Staff assignments Resource and supply acquisition Ancillary support teams 6 3

Decompression of the ED Influx of patients presenting to the ED Support decompression by rapid response from the inpatient areas Inpatient response automated to the ED Response supported by temporary placement in hallway beds Maintain ratios ED Physician assessment for admission Code Triage order sets 7 Code Triage Hallway Bed Patient Criteria Med/surg patient No requirements for: Oxygen Critical care Telemetry Isolation Psychiatric hold 8 4

Initiation of a Code Triage News received of a mass casualty ED contacts Nursing Supervisor Decision for Code Triage Alert or Full Operator contacted overhead page and WarnMe alerts Nursing Supervisor oversees Code Triage and transfer of patients ED Charge Nurse prepares for ED Mass Triage Plan ED Physicians review patient population 9 Automated Response Patient Care Services Patient Movers respond to ED Hallway Patient Movers transport ED patient Inpatient units absorb 3-4 patients Charge Nurses assign patients to hallway bed Inpatient Nurse assigned to patient 10 5

Patient Care Services Position Check Lists Nurse Supervisor Charge Nurse Patient Mover (Nurse) Lift Team and Transport Bed Control 11 Code Triage Staging Hallway Route Map 12 6

ED Decompression Response ED Flow Coordinator identifies eligible patients with existing admission orders and contacts Bed Control directly. ED Attending identifies Code Triage patient admissions, patient reviews and communicates with hospitalist. 13 Hospitalist Service Role Identify patient admissions using Electronic Health Record ED Trackboard Use Code Triage order set for admission Assure clinical qualifications Full admit orders to be completed in 2-8 hours 14 7

Emergency Department/ Hospitalist Go Cards ED Charge Nurse Lead Triage Nurse/Triage Area Manager Flow Coordinator ED Nurse Check-in/Staging Lead ED Clerk Trackboard Lead ED Clerk Runner ED Tech Staging Hallway Lead ED Tech 15 Emergency Department/ Hospitalist Go Cards (cont.) Lead Attending/Treatment Area Manager ED Attending Physician Pod Attending Hospitalist 16 8

Information Technology Role ED Trackboard Code Triage Hallable Admission/bed request created from Code Triage order set Hallway Beds interfaced with applications Viewable in Electronic Health Record Interfaced to support care Exercise environment and access Code Triage Order Sets 17 Code Triage Orders Defaults Admit Patient for Neurological & Vascular Observation Checks NPO Pulse Oximetry Vital Signs NaCl.9% IV Maintenance Ambulate with Assistance Foley Catheter BMP/CBC/Blood Gas Intake/Output Venous POC Glucose Saline Lock 18 9

Code Triage Drills Code Triage Drills Quarterly Goal Preset dates Work within production copy environment Pre meetings and announcements Intra Department participation Use tools Debrief as a group Corrective actions taken prior to next drill 19 Strategies for Success Automation of Process Communication of the plan Support from Hospitalist Patient Care Services Support Trust Practice Drill, Drill, Drill Corrective actions Communication 20 10

Future Goals Develop ED and inpatient support plans Include support areas in drills Expand patient criteria to include other populations 21 Questions? Don t forget to complete your evaluation! If you do not have access to the app, please see CHA staff for a printed evaluation. CE certificates will be emailed within two weeks of the conference. 11

Thank you! Stacey Gustafson UC Davis Medical Center sgustafson@ucdavis.edu Joleen Lonigan UC Davis Medical Center jalonigan@ucdavis.edu 12