Pandemic Influenza Planning: SickKids Approach

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Pandemic Influenza Planning SickKids
Approach

• Anne Matlow MD FRCPC
• Chair, Pandemic Influenza Planning Steering
  Committee
• June 27, 2006

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PIP TIMELINE
Approve StrategyEstablish SubctteesIdentify
fill gapsFinal Plan
OBJECTIVES
Planning Meeting Steering Cttee
Sub-committees formed
Working groups active
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PIP Steering Committee ASSEMBLE KEY
STAKEHOLDERS!!

• Chair
• Executive sponsor
• Occupational Health and Safety
• Infection Prevention and Control
• Infectious Diseases
• Public Affairs
• Critical Care Unit
• Human Resources
• Quality and Risk Management
• Emergency measures
• Finance
• Child Health Services Directors
• Bioethics Research Institute, Family
  Advisory Committee

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Executive
TAHSN
OHPIP
PIP Steering Committee

Patient Management
Capacity
Communication /Education
Staff Safety Support
Human Resources

• Clinical
• Operational

• Triage
• Vaccine
• Antiviral
• Antibiotics
• Microbiological sampling
• Infection Control
• Medical Records

• Staffing s
• Deployment

• vaccine and meds for staff
• Staff safety

Research Institute
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Local Needs based on Flusurge

• Population of 1,318,811 age 0-19, estimating 8
  week pandemic wave with 35 attack rate
• close to 900 admissions over 8
  weeks, peaking at week 4, with 50 deaths.
• at the peak of the outbreak, there
  will be 170 weekly admissions,
• 30 of the hospital filled with influenza
  patients
• 18 of the ICU capacity
• 35 of the ventilators.

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MOHLTC Assumptions

• 15-35 of population will be ill (staff included)
• Hospitals will be overwhelmed
• Vaccine will not be available for first wave
• Vaccine and antivirals will be in short supply
• Non life-threatening services may be curtailed or
  consolidated.
• Care protocols may need to change/ be adapted for
  pandemic times.
• Centralized purchase of equipment,
  vaccines/antivirals by MOHLTC

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Toronto Academic Health Sciences Network
(TAHSN) Plan

• Take care of Health Care Workers in order to
  enable patient care
• Support MOHLTC strategy to provide care to those
  with best possibility of survival.
• Prepandemic and pandemic education needed
• Coordination of essential services, programmes
• Standardize communications and procedures across
  the network

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SickKids Assumptions

• SickKids will be responsible for the care of
  almost all children in the GTA who require
  critical care beds.
• The pandemic influenza response will be managed
  through the Incident Management System
• Individual staff may be seconded by the province

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WHO Pandemic period and phases
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Pandemic Influenza Planning

• PANDEMIC
• capacity
• COMMUNICATION/ EDUCATION
• PT MANAGEMENT
• HR
• SAFETY
• RESEARCH INSTITUTE

• PREPANDEMIC
• CAPACITY
• communication/ education
• PT MANAGEMENT
• HR
• SAFETY
• RESEARCH INSTITUTE

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CAPACITY

• We will have 2 EDs one for non- I/ILI patients
  one for I/ILI patients
• Ambulance access coordinated with patients
  directed to appropriate ED
• New ambulatory triage area
• Revised screening tools
• Each clinical programme as well as Support
  Services have planned for 10, 15, 20, 50
  reductions in activity
• 10 stock-piling of supplies
• Plans to increase critical care capacity and
  in-patient beds if required
• Twice daily capacity assessment during pandemic

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Patient Management

• Pre-pandemic and pandemic case definitions
  established for use at triage
• Pre-pandemic all children with S/S and epi link
  admitted More IC precautions used
• Guidelines for antiviral and antibacterial use
  and supportive therapy established
• working to facilitate approval of protocols for
  experimental drugs if required
• Laboratory testing algorithms established
• Ethical framework to be applied

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Human Resources

• Consistency of policies procedures
• Work with Staff Safety Subcommittee, other HR,
  TAHSN, CUPE
• Maintain adequate staffing through redeployment,
  rehiring and fast track new hires etc
• Redeployment centre to be developed
• Compensation and benefit plans have been updated
  to align with TAHSN
• Importance of ongoing communication

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Human Resources MDs

• MDs required to maintain minimal essential
  services has been defined for each service
• List of current full and part time MDs to be
  generated yearly through credentialing Skill
  sets to be determined
• Have ability to expand MD work force

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Staff Support and Safety

• Protect staff with appropriate administrative ,
  engineering controls and PPE
• Enhanced wellness campaign pre-pandemic member
  of JOHSC work with PIP communications during
  pandemic, EAP
• Care for sick staff enhanced STARS program,
  on-site assessment, define fitness to return to
  work
• Process for vaccination, antivirals etc for staff
• Continue reporting obligations

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Communication/ Education

• Materials directed to staff as well as patients/
  families/ public
• Multi-modal open fora, posters, email, web,
  HSC-TV etc, news release
• Pre-pandemic General pandemic influenza
  knowledge, respiratory protection, healthy
  behaviours
• Pandemic ongoing education (eg protocols,
  self-care etc) and information (eg directives
  from IMS, visiting policies, disruptions, )

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..an evergreen document.