Chapter 7 COORDINATION WITH HMDOs [ENTER FACILITATORS NAME AND CONTACT INFORMATION] Developed by Troutman Sanders LLP Developed for the Virginia Department of Health Funded by Centers for Disease Control and Prevention

2Coordination with HMDOs

3 Toolkit Presentations Instructions for Use Toolkit Presentations are intended to be a companion to the Hospital Implementation Guide and should not be used in isolation. The Presentations are intended to serve as a starting point for the facilitator. The facilitator should thoroughly review the Presentation prior to use in Implementation Team, CRAG or Subcommittee meetings and customize the Presentation to meet the unique needs of the meeting participants. Pay particular to attention to the information provided in brackets ([ ]), which must be completed by the facilitator prior to use. Included in the Notes section of each slide are the following types of information: Slide Type, which indicates whether the slide is for information or discussion, serves as a placeholder, or is some combination thereof Planning Guide Section(s), which will direct the facilitator to the corresponding sections of the Planning Guide and Hospital Implementation Guide for further information Special Instructions, which provides directions for the facilitator to customize the slide for the intended audience Speakers Notes, which provides more detailed information to supplement the material on the slide Refer to the Hospital Implementation Guide for further guidance and helpful hints on effectively completing the process described in the Planning Guide.

4Coordination with HMDOs CRAG Members [Enter names and departments of each CRAG member]

5Coordination with HMDOs Add slides from Altered Standards Overview and/or Chapter 1 presentation, as needed, to re-introduce the CRAG to the concept of altered standards and critical resource shortage response planning, especially if new members are involved.

6Coordination with HMDOs Introduction

7Coordination with HMDOs Chapter Overview Identify HMDOs for coordination Create a communication strategy with other HMDOs Understand how HMDOs responses to the CRSE will impact other HMDOs Engage in discussions regarding changes to scope of services Expansion of scope Reduction of scope Discuss cooperative initiatives with other HMDOs Establish parameters regarding essential documentation

8Coordination with HMDOs Hospital(s) in Planning Unit Other HMDOs Coordination During Normal Times

9Coordination with HMDOs Hospital(s) in Planning Unit Other HMDOs Patient Care in CRSE Without Coordinated Planning Smaller degree of overlap Each will retreat into its own silo and implement its own disaster plan Non-Productive Interaction

10Coordination with HMDOs Hospital(s) in Planning Unit Other HMDOs Patient Care in CRSE With Coordinated Planning Higher degree of overlap Both entities will rely on each other to do more Productive Interaction

11Coordination with HMDOs Hospital(s) in Planning Unit Other HMDOs Patient Care in CRSE With Coordinated Planning What exactly does this coordination look like during a CRSE?

12Coordination with HMDOs Decisions for the Planning Unit With which HMDOs are we going to coordinate? How are we going to coordinate with the selected HMDOs? Will we expect these HMDOs to change their scope of services to support our response to the CRSE? If so, how? Are there any cooperative initiatives that we want to pursue with other HMDOs? What problems, if any, do we see with essential documentation between the hospital(s) in the Planning Unit and HMDOs?

13Coordination with HMDOs Selecting HMDOs for Coordination

14Coordination with HMDOs Selecting HMDOs for Coordination There are a vast number of other HMDOs in the [Planning Unit] It will be difficult to coordinate with each type of HMDO It will be almost impossible to coordinate with individual HMDOs (e.g., each EMS provider) The CRAG will have to prioritize types of HMDOs for coordination efforts

15Coordination with HMDOs Brainstorm a List of Other HMDOs EMS Providers Community Physicians Ambulatory Surgery Centers Home Health Assisted Living Long Term Care Dialysis Facilities Community Health Centers FQHCs Hospice Outpatient Lab Infusion Centers Outpatient Imaging Rehabilitation Hospitals Alternate Care Facilities Other Acute Care Facilities Pharmacy

16Coordination with HMDOs Prioritize the HMDOs for Coordination Which HMDOs may be able to help protect the hospital(s) in the Planning Unit from being overwhelmed during a CRSE by providing certain types of care or early triage? Which HMDOs may pose a risk to hospital(s) in the Planning Unit during a CRSE because they have the potential to transfer large numbers of patients to the hospital(s)?

17Coordination with HMDOs Prioritizing HMDOs for Coordination High PriorityMedium PriorityLow Priority

18Coordination with HMDOs Coordination Strategy

19Coordination with HMDOs Coordination Considerations HMDO representative bodies v. each individual HMDO CRAG v. selected representative(s) of the CRAG Methods of communication with the HMDOs

20Coordination with HMDOs Representative Body v. Individual HMDOs

21Coordination with HMDOs CRAG v. Representative(s) of the CRAG

22Coordination with HMDOs Communication Methods

23Coordination with HMDOs Scope of Services

24Coordination with HMDOs Changes to Scope of Services HMDOs may be planning to change their scope of services as part of their critical resource shortage response plans The Planning Units CRSRP and associated Protocols may be more effective if other HMDOs change their scope of services Expansion Reduction

25Coordination with HMDOs CRSRP and Associated Protocols Ethical framework Operational infrastructure Protocols [LIST ALL RESOURCE-SPECIFIC PROTOCOLS] Ad Hoc Protocol Development Infrastructure Evaluation and Maintenance Approval and Integration Communication

26Coordination with HMDOs EXPANSION [Can any care be performed by other HMDOs to provide relief to the hospital(s) in the Planning Unit?] [Can any additional testing or services be performed at other HMDOs to facilitate the hospitals implementation of Protocols?]

27Coordination with HMDOs [Is there any care that may be provided by other HMDOs that will negatively impact a hospitals ability to implement a Protocol?] [If so, does it make sense to ask these other HMDOs to limit this type of care?] REDUCTION

28Coordination with HMDOs Other Collaboration Issues

29Coordination with HMDOs Are there any cooperative initiatives that we want to pursue with other HMDOs? Cooperative stockpiling Ambulance re-stocking SNS distribution Alternate care facility

30Coordination with HMDOs What problems, if any, do we see with essential documentation between the hospital(s) in the Planning Unit and HMDOs? [INSERT DEFINITION OF ESSENTIAL DOCUMENTATION FROM SECTION 4.5]

31Coordination with HMDOs Essential Documentation What documentation is used today? Is all of todays documentation necessary during a CRSE? What is the minimum amount of information needed? What information is needed for reimbursement purposes? Essential Documentation between the Hospital(s) in the Planning Unit and HMDOs

32Coordination with HMDOs BREAK

33Coordination with HMDOs HMDO Coordination

34Coordination with HMDOs Summary of Discussions with HMDOs [WHICH HMDOs WERE CONTACTED] [NUMBER AND TYPES OF COMMUNICATIONS/MEETINGS] [PARTICIPANTS IN DISCUSSIONS] [GENERAL TOPICS OF COMMUNICATIONS/MEETINGS]

35Coordination with HMDOs HMDO Response to a CRSE HMDOs response is designed to support its continuity of operations [DETAILS REGARDING HMDOS CRITICAL RESOURCE SHORTAGE RESPONSE PLAN, IF ANY] [CHANGES TO SCOPE OF SERVICES] [ASSUMPTIONS THAT HMDO IS MAKING ABOUT THE HOSPITAL(S) IN THE PLANNING UNIT]

36Coordination with HMDOs HMDO Response to a CRSE [PRELIMINARY CONCLUSIONS ABOUT IMPACT THAT HMDO RESPONSE TO A CRSE WILL HAVE ON THE HOSPITAL(S) IN THE PLANNING UNIT]

37Coordination with HMDOs HMDOs Willingness to Change its Scope of Services [SUMMARY OF THE ASK – HOW DID THE CRAG WANT THE HMDO TO CHANGE ITS SCOPE OF SERVICES TO SUPPORT THE PLANNING UNITS CRSRP AND ASSOCIATED PROTOCOLS?] [SUMMARY OF THE HMDOS RESPONSE]

38Coordination with HMDOs [PRELIMINARY CONCLUSIONS ABOUT IMPACT THAT HMDOS RESPONSE TO REQUEST TO CHANGE ITS SCOPE OF SERVICES WILL HAVE ON THE HOSPITAL(S) IN THE PLANNING UNIT] HMDOs Willingness to Change its Scope of Services

39Coordination with HMDOs HMDOS Interest in Pursuing Cooperative Initiatives [SUMMARY OF PROPOSED INITIATIVES] [SUMMARY OF HMDOS INTEREST IN PURSUING SUGGESTED COOPERATIVE INITIATIVES] [HMDOS CONCERNS ABOUT COOPERATIVE INITIATIVES]

40Coordination with HMDOs HMDOs Ability to Provide Essential Documentation [CHANGES THAT THE HMDOs ARE PLANNING TO MAKE TO THEIR DOCUMENTATION DURING A CRSE] [SUMMARY OF COMPONENTS OF ESSENTIAL DOCUMENTATION FOR HMDO THAT CRAG IDENTIFIED] [ABILITY TO SUPPORT THE SUGGESTED COMPONENTS OF ESSENTIAL DOCUMENTATION AS IDENTIFIED BY THE CRAG]

41Coordination with HMDOs HMDOs Ability to Provide Essential Documentation [PRELIMINARY CONCLUSIONS ABOUT THE IMPACT THAT HMDOS ABILITY TO SUPPORT COMPONENTS OF ESSENTIAL DOCUMENTATION WILL HAVE ON THE HOSPITAL(S) IN THE PLANNING UNIT]

42Coordination with HMDOs Next Steps in Coordination with HMDOs [Preliminary suggestions for next steps in the coordination effort with other HMDOs]

43Coordination with HMDOs Modifications to CRSRP or Associated Protocols [Preliminary suggestions for modifying the CRSRP or associated Protocols as a result of the coordination among the hospital(s) in the Planning Unit and HMDOs]

44Coordination with HMDOs Questions?