ensuring healthcare safety throughout the covid-19 pandemic · patient safety: a systematic review....
TRANSCRIPT
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TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Ensuring Healthcare Safety Throughout the COVID-19 Pandemic
June 2 2020
Access the recorded webinar here httpsregistergotowebinarcomrecording1770593459557872143
Access speaker bios here httpsfilesasprtraciehhsgovdocumentsaspr-tracie-ensuring-healthcare-safety-throughout-the-covid-19-pandemic-webinar-speaker-biospdf
Access Q amp A here httpsfilesasprtraciehhsgovdocumentsaspr-tracie-ta-covid-19-healthcare-safety-qapdf
UnclassifiedFor Public Use
UnclassifiedFor Public Use
llirL TECHNICAL IIPr RESOURCE$
__II_ ASS ISTANCE CENTER
J ~ INFORMATION ~ EXCHANGE
asprtraciehhsgov
1-844-5-TRACIE
askasprtraciehhsgov
ASPR AUIS1ANT bulllCUTtamp~ ~00
UIPAUDgt1111 ~gtIC UfPO~H HUtTHCdl h oUGpound NC1 HpoundhH0Npound~~
I NfORMAT IONGAIEWAf
ASPR TRACIE Three Domains
bull Self-service collection of audience-tailored materials bull Subject-specific SME-reviewed ldquoTopic Collectionsrdquo bull Unpublished and SME peer-reviewed materials
highlighting real-life tools and experiences
bull Personalized support and responses to requests forinformation and technical assistance
bull Accessible by toll-free number (1844-5-TRACIE)email (askasprtraciehhsgov) or web form (ASPRtraciehhsgov)
bull Area for password-protected discussion amongvetted users in near real-time
bull Ability to support chats and the peer-to-peerexchange of user-developed templates plans andother materials
2
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resources bull ASPR TRACIE COVID-19 Page bull ASPR COVID-19 Page bull AHRQ COVID-19 Page bull CDC COVID-19 Page bull Coronavirusgov bull HRSA COVID-19 Page
3
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Moderator- Meghan Treber MS ASPR TRACIE
UnclassifiedFor Public Use
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Erin Fowler MS BSN Senior Advisor Office of Global Health Health Resources and Services Administration (HRSA)
UnclassifiedFor Public Use
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Jeff Brady MD MPH Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Richard Nesto MD Chief Medical Officer Beth Israel Lahey Health (Massachusetts)
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
About Beth Israel Lahey Health (BILH)
bull Formed in March of 2019 BILH is the second largesthealthcare system in New England and second largestemployer in Massachusetts ndash with nearly $6 billion in operating revenue 13 hospitals 4300 physicians and35000 employees serving over one million patients
bull BILH is anchored by three academic medical centers andteaching hospitals a market-leading orthopedic hospitaland a full continuum of services spanning primary andspecialty care community acute care ambulatory carebehavioral health and home health
8
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CKE RS ---------shy
Clinical Leadership amp Infection Control
JAMA The Journal of the American Medical Association
Why hospita W Hospital Mergers Improve Health Why hospital mergers may harm care quality Evidence Shows the Opposite February 11 2019 February 11 2019
The Risks to Patient Safety From Health System Expansions Susan Haas MD MSc Atul Gawande MD MPH Mark E Reynolds April 6 2018
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Do Mergers Lead to Better Quality
9
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Setting the Tone of Transparency in Leadership and Governance bull Gestation (2018 ndash 1 year pre-merger)
mdash Board composition without dominance of a single entity mdash 30 Design Team meetings with cross system representation
bull Launch (2019) mdash Senatorial model or representation for system quality P+T
meetings and Physician Advisory Council
bull Readiness for COVID 19 (2020) mdash Ahead of the game in preparedness
10
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull System Quality Forum relationships (CMOs CNOs quality directors case managers) facilitated system planning and response
bull Incorporated surrounding community hospitals in our huddles bull Our orthopedic specialty hospital repurposed to a medical and
psych hospital to accept COVID negative patients from other BILH hospitals (100+ admissions) to make room for COVID + patients
11
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull A Virtual Transfer Center was incorporated to manage access across system
bull Critical Care Group formed composed of ICU leaders of our 3tertiary care hospitals
mdash Twice-daily huddles to assess real-time ICU bed andventilator supply across our 11 med-surg hospitals
mdash Load balanced patients and ventilators to ensure eachhospital could manage capacity
bull MedSurg Care Group with daily huddles to assess real-time bedcapacity to load balance patients across 11 system hospitals
12
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
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Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
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Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
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I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
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Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
llirL TECHNICAL IIPr RESOURCE$
__II_ ASS ISTANCE CENTER
J ~ INFORMATION ~ EXCHANGE
asprtraciehhsgov
1-844-5-TRACIE
askasprtraciehhsgov
ASPR AUIS1ANT bulllCUTtamp~ ~00
UIPAUDgt1111 ~gtIC UfPO~H HUtTHCdl h oUGpound NC1 HpoundhH0Npound~~
I NfORMAT IONGAIEWAf
ASPR TRACIE Three Domains
bull Self-service collection of audience-tailored materials bull Subject-specific SME-reviewed ldquoTopic Collectionsrdquo bull Unpublished and SME peer-reviewed materials
highlighting real-life tools and experiences
bull Personalized support and responses to requests forinformation and technical assistance
bull Accessible by toll-free number (1844-5-TRACIE)email (askasprtraciehhsgov) or web form (ASPRtraciehhsgov)
bull Area for password-protected discussion amongvetted users in near real-time
bull Ability to support chats and the peer-to-peerexchange of user-developed templates plans andother materials
2
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resources bull ASPR TRACIE COVID-19 Page bull ASPR COVID-19 Page bull AHRQ COVID-19 Page bull CDC COVID-19 Page bull Coronavirusgov bull HRSA COVID-19 Page
3
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Moderator- Meghan Treber MS ASPR TRACIE
UnclassifiedFor Public Use
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Erin Fowler MS BSN Senior Advisor Office of Global Health Health Resources and Services Administration (HRSA)
UnclassifiedFor Public Use
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Jeff Brady MD MPH Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Richard Nesto MD Chief Medical Officer Beth Israel Lahey Health (Massachusetts)
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
About Beth Israel Lahey Health (BILH)
bull Formed in March of 2019 BILH is the second largesthealthcare system in New England and second largestemployer in Massachusetts ndash with nearly $6 billion in operating revenue 13 hospitals 4300 physicians and35000 employees serving over one million patients
bull BILH is anchored by three academic medical centers andteaching hospitals a market-leading orthopedic hospitaland a full continuum of services spanning primary andspecialty care community acute care ambulatory carebehavioral health and home health
8
UnclassifiedFor Public Use
CKE RS ---------shy
Clinical Leadership amp Infection Control
JAMA The Journal of the American Medical Association
Why hospita W Hospital Mergers Improve Health Why hospital mergers may harm care quality Evidence Shows the Opposite February 11 2019 February 11 2019
The Risks to Patient Safety From Health System Expansions Susan Haas MD MSc Atul Gawande MD MPH Mark E Reynolds April 6 2018
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Do Mergers Lead to Better Quality
9
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Setting the Tone of Transparency in Leadership and Governance bull Gestation (2018 ndash 1 year pre-merger)
mdash Board composition without dominance of a single entity mdash 30 Design Team meetings with cross system representation
bull Launch (2019) mdash Senatorial model or representation for system quality P+T
meetings and Physician Advisory Council
bull Readiness for COVID 19 (2020) mdash Ahead of the game in preparedness
10
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull System Quality Forum relationships (CMOs CNOs quality directors case managers) facilitated system planning and response
bull Incorporated surrounding community hospitals in our huddles bull Our orthopedic specialty hospital repurposed to a medical and
psych hospital to accept COVID negative patients from other BILH hospitals (100+ admissions) to make room for COVID + patients
11
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull A Virtual Transfer Center was incorporated to manage access across system
bull Critical Care Group formed composed of ICU leaders of our 3tertiary care hospitals
mdash Twice-daily huddles to assess real-time ICU bed andventilator supply across our 11 med-surg hospitals
mdash Load balanced patients and ventilators to ensure eachhospital could manage capacity
bull MedSurg Care Group with daily huddles to assess real-time bedcapacity to load balance patients across 11 system hospitals
12
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resources bull ASPR TRACIE COVID-19 Page bull ASPR COVID-19 Page bull AHRQ COVID-19 Page bull CDC COVID-19 Page bull Coronavirusgov bull HRSA COVID-19 Page
3
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Moderator- Meghan Treber MS ASPR TRACIE
UnclassifiedFor Public Use
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Erin Fowler MS BSN Senior Advisor Office of Global Health Health Resources and Services Administration (HRSA)
UnclassifiedFor Public Use
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Jeff Brady MD MPH Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Richard Nesto MD Chief Medical Officer Beth Israel Lahey Health (Massachusetts)
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
About Beth Israel Lahey Health (BILH)
bull Formed in March of 2019 BILH is the second largesthealthcare system in New England and second largestemployer in Massachusetts ndash with nearly $6 billion in operating revenue 13 hospitals 4300 physicians and35000 employees serving over one million patients
bull BILH is anchored by three academic medical centers andteaching hospitals a market-leading orthopedic hospitaland a full continuum of services spanning primary andspecialty care community acute care ambulatory carebehavioral health and home health
8
UnclassifiedFor Public Use
CKE RS ---------shy
Clinical Leadership amp Infection Control
JAMA The Journal of the American Medical Association
Why hospita W Hospital Mergers Improve Health Why hospital mergers may harm care quality Evidence Shows the Opposite February 11 2019 February 11 2019
The Risks to Patient Safety From Health System Expansions Susan Haas MD MSc Atul Gawande MD MPH Mark E Reynolds April 6 2018
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Do Mergers Lead to Better Quality
9
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Setting the Tone of Transparency in Leadership and Governance bull Gestation (2018 ndash 1 year pre-merger)
mdash Board composition without dominance of a single entity mdash 30 Design Team meetings with cross system representation
bull Launch (2019) mdash Senatorial model or representation for system quality P+T
meetings and Physician Advisory Council
bull Readiness for COVID 19 (2020) mdash Ahead of the game in preparedness
10
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull System Quality Forum relationships (CMOs CNOs quality directors case managers) facilitated system planning and response
bull Incorporated surrounding community hospitals in our huddles bull Our orthopedic specialty hospital repurposed to a medical and
psych hospital to accept COVID negative patients from other BILH hospitals (100+ admissions) to make room for COVID + patients
11
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull A Virtual Transfer Center was incorporated to manage access across system
bull Critical Care Group formed composed of ICU leaders of our 3tertiary care hospitals
mdash Twice-daily huddles to assess real-time ICU bed andventilator supply across our 11 med-surg hospitals
mdash Load balanced patients and ventilators to ensure eachhospital could manage capacity
bull MedSurg Care Group with daily huddles to assess real-time bedcapacity to load balance patients across 11 system hospitals
12
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Moderator- Meghan Treber MS ASPR TRACIE
UnclassifiedFor Public Use
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Erin Fowler MS BSN Senior Advisor Office of Global Health Health Resources and Services Administration (HRSA)
UnclassifiedFor Public Use
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Jeff Brady MD MPH Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Richard Nesto MD Chief Medical Officer Beth Israel Lahey Health (Massachusetts)
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
About Beth Israel Lahey Health (BILH)
bull Formed in March of 2019 BILH is the second largesthealthcare system in New England and second largestemployer in Massachusetts ndash with nearly $6 billion in operating revenue 13 hospitals 4300 physicians and35000 employees serving over one million patients
bull BILH is anchored by three academic medical centers andteaching hospitals a market-leading orthopedic hospitaland a full continuum of services spanning primary andspecialty care community acute care ambulatory carebehavioral health and home health
8
UnclassifiedFor Public Use
CKE RS ---------shy
Clinical Leadership amp Infection Control
JAMA The Journal of the American Medical Association
Why hospita W Hospital Mergers Improve Health Why hospital mergers may harm care quality Evidence Shows the Opposite February 11 2019 February 11 2019
The Risks to Patient Safety From Health System Expansions Susan Haas MD MSc Atul Gawande MD MPH Mark E Reynolds April 6 2018
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Do Mergers Lead to Better Quality
9
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Setting the Tone of Transparency in Leadership and Governance bull Gestation (2018 ndash 1 year pre-merger)
mdash Board composition without dominance of a single entity mdash 30 Design Team meetings with cross system representation
bull Launch (2019) mdash Senatorial model or representation for system quality P+T
meetings and Physician Advisory Council
bull Readiness for COVID 19 (2020) mdash Ahead of the game in preparedness
10
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull System Quality Forum relationships (CMOs CNOs quality directors case managers) facilitated system planning and response
bull Incorporated surrounding community hospitals in our huddles bull Our orthopedic specialty hospital repurposed to a medical and
psych hospital to accept COVID negative patients from other BILH hospitals (100+ admissions) to make room for COVID + patients
11
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull A Virtual Transfer Center was incorporated to manage access across system
bull Critical Care Group formed composed of ICU leaders of our 3tertiary care hospitals
mdash Twice-daily huddles to assess real-time ICU bed andventilator supply across our 11 med-surg hospitals
mdash Load balanced patients and ventilators to ensure eachhospital could manage capacity
bull MedSurg Care Group with daily huddles to assess real-time bedcapacity to load balance patients across 11 system hospitals
12
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Erin Fowler MS BSN Senior Advisor Office of Global Health Health Resources and Services Administration (HRSA)
UnclassifiedFor Public Use
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Jeff Brady MD MPH Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Richard Nesto MD Chief Medical Officer Beth Israel Lahey Health (Massachusetts)
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
About Beth Israel Lahey Health (BILH)
bull Formed in March of 2019 BILH is the second largesthealthcare system in New England and second largestemployer in Massachusetts ndash with nearly $6 billion in operating revenue 13 hospitals 4300 physicians and35000 employees serving over one million patients
bull BILH is anchored by three academic medical centers andteaching hospitals a market-leading orthopedic hospitaland a full continuum of services spanning primary andspecialty care community acute care ambulatory carebehavioral health and home health
8
UnclassifiedFor Public Use
CKE RS ---------shy
Clinical Leadership amp Infection Control
JAMA The Journal of the American Medical Association
Why hospita W Hospital Mergers Improve Health Why hospital mergers may harm care quality Evidence Shows the Opposite February 11 2019 February 11 2019
The Risks to Patient Safety From Health System Expansions Susan Haas MD MSc Atul Gawande MD MPH Mark E Reynolds April 6 2018
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Do Mergers Lead to Better Quality
9
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Setting the Tone of Transparency in Leadership and Governance bull Gestation (2018 ndash 1 year pre-merger)
mdash Board composition without dominance of a single entity mdash 30 Design Team meetings with cross system representation
bull Launch (2019) mdash Senatorial model or representation for system quality P+T
meetings and Physician Advisory Council
bull Readiness for COVID 19 (2020) mdash Ahead of the game in preparedness
10
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull System Quality Forum relationships (CMOs CNOs quality directors case managers) facilitated system planning and response
bull Incorporated surrounding community hospitals in our huddles bull Our orthopedic specialty hospital repurposed to a medical and
psych hospital to accept COVID negative patients from other BILH hospitals (100+ admissions) to make room for COVID + patients
11
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull A Virtual Transfer Center was incorporated to manage access across system
bull Critical Care Group formed composed of ICU leaders of our 3tertiary care hospitals
mdash Twice-daily huddles to assess real-time ICU bed andventilator supply across our 11 med-surg hospitals
mdash Load balanced patients and ventilators to ensure eachhospital could manage capacity
bull MedSurg Care Group with daily huddles to assess real-time bedcapacity to load balance patients across 11 system hospitals
12
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Jeff Brady MD MPH Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Richard Nesto MD Chief Medical Officer Beth Israel Lahey Health (Massachusetts)
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
About Beth Israel Lahey Health (BILH)
bull Formed in March of 2019 BILH is the second largesthealthcare system in New England and second largestemployer in Massachusetts ndash with nearly $6 billion in operating revenue 13 hospitals 4300 physicians and35000 employees serving over one million patients
bull BILH is anchored by three academic medical centers andteaching hospitals a market-leading orthopedic hospitaland a full continuum of services spanning primary andspecialty care community acute care ambulatory carebehavioral health and home health
8
UnclassifiedFor Public Use
CKE RS ---------shy
Clinical Leadership amp Infection Control
JAMA The Journal of the American Medical Association
Why hospita W Hospital Mergers Improve Health Why hospital mergers may harm care quality Evidence Shows the Opposite February 11 2019 February 11 2019
The Risks to Patient Safety From Health System Expansions Susan Haas MD MSc Atul Gawande MD MPH Mark E Reynolds April 6 2018
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Do Mergers Lead to Better Quality
9
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Setting the Tone of Transparency in Leadership and Governance bull Gestation (2018 ndash 1 year pre-merger)
mdash Board composition without dominance of a single entity mdash 30 Design Team meetings with cross system representation
bull Launch (2019) mdash Senatorial model or representation for system quality P+T
meetings and Physician Advisory Council
bull Readiness for COVID 19 (2020) mdash Ahead of the game in preparedness
10
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull System Quality Forum relationships (CMOs CNOs quality directors case managers) facilitated system planning and response
bull Incorporated surrounding community hospitals in our huddles bull Our orthopedic specialty hospital repurposed to a medical and
psych hospital to accept COVID negative patients from other BILH hospitals (100+ admissions) to make room for COVID + patients
11
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull A Virtual Transfer Center was incorporated to manage access across system
bull Critical Care Group formed composed of ICU leaders of our 3tertiary care hospitals
mdash Twice-daily huddles to assess real-time ICU bed andventilator supply across our 11 med-surg hospitals
mdash Load balanced patients and ventilators to ensure eachhospital could manage capacity
bull MedSurg Care Group with daily huddles to assess real-time bedcapacity to load balance patients across 11 system hospitals
12
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Richard Nesto MD Chief Medical Officer Beth Israel Lahey Health (Massachusetts)
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
About Beth Israel Lahey Health (BILH)
bull Formed in March of 2019 BILH is the second largesthealthcare system in New England and second largestemployer in Massachusetts ndash with nearly $6 billion in operating revenue 13 hospitals 4300 physicians and35000 employees serving over one million patients
bull BILH is anchored by three academic medical centers andteaching hospitals a market-leading orthopedic hospitaland a full continuum of services spanning primary andspecialty care community acute care ambulatory carebehavioral health and home health
8
UnclassifiedFor Public Use
CKE RS ---------shy
Clinical Leadership amp Infection Control
JAMA The Journal of the American Medical Association
Why hospita W Hospital Mergers Improve Health Why hospital mergers may harm care quality Evidence Shows the Opposite February 11 2019 February 11 2019
The Risks to Patient Safety From Health System Expansions Susan Haas MD MSc Atul Gawande MD MPH Mark E Reynolds April 6 2018
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Do Mergers Lead to Better Quality
9
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Setting the Tone of Transparency in Leadership and Governance bull Gestation (2018 ndash 1 year pre-merger)
mdash Board composition without dominance of a single entity mdash 30 Design Team meetings with cross system representation
bull Launch (2019) mdash Senatorial model or representation for system quality P+T
meetings and Physician Advisory Council
bull Readiness for COVID 19 (2020) mdash Ahead of the game in preparedness
10
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull System Quality Forum relationships (CMOs CNOs quality directors case managers) facilitated system planning and response
bull Incorporated surrounding community hospitals in our huddles bull Our orthopedic specialty hospital repurposed to a medical and
psych hospital to accept COVID negative patients from other BILH hospitals (100+ admissions) to make room for COVID + patients
11
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull A Virtual Transfer Center was incorporated to manage access across system
bull Critical Care Group formed composed of ICU leaders of our 3tertiary care hospitals
mdash Twice-daily huddles to assess real-time ICU bed andventilator supply across our 11 med-surg hospitals
mdash Load balanced patients and ventilators to ensure eachhospital could manage capacity
bull MedSurg Care Group with daily huddles to assess real-time bedcapacity to load balance patients across 11 system hospitals
12
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
About Beth Israel Lahey Health (BILH)
bull Formed in March of 2019 BILH is the second largesthealthcare system in New England and second largestemployer in Massachusetts ndash with nearly $6 billion in operating revenue 13 hospitals 4300 physicians and35000 employees serving over one million patients
bull BILH is anchored by three academic medical centers andteaching hospitals a market-leading orthopedic hospitaland a full continuum of services spanning primary andspecialty care community acute care ambulatory carebehavioral health and home health
8
UnclassifiedFor Public Use
CKE RS ---------shy
Clinical Leadership amp Infection Control
JAMA The Journal of the American Medical Association
Why hospita W Hospital Mergers Improve Health Why hospital mergers may harm care quality Evidence Shows the Opposite February 11 2019 February 11 2019
The Risks to Patient Safety From Health System Expansions Susan Haas MD MSc Atul Gawande MD MPH Mark E Reynolds April 6 2018
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Do Mergers Lead to Better Quality
9
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Setting the Tone of Transparency in Leadership and Governance bull Gestation (2018 ndash 1 year pre-merger)
mdash Board composition without dominance of a single entity mdash 30 Design Team meetings with cross system representation
bull Launch (2019) mdash Senatorial model or representation for system quality P+T
meetings and Physician Advisory Council
bull Readiness for COVID 19 (2020) mdash Ahead of the game in preparedness
10
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull System Quality Forum relationships (CMOs CNOs quality directors case managers) facilitated system planning and response
bull Incorporated surrounding community hospitals in our huddles bull Our orthopedic specialty hospital repurposed to a medical and
psych hospital to accept COVID negative patients from other BILH hospitals (100+ admissions) to make room for COVID + patients
11
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull A Virtual Transfer Center was incorporated to manage access across system
bull Critical Care Group formed composed of ICU leaders of our 3tertiary care hospitals
mdash Twice-daily huddles to assess real-time ICU bed andventilator supply across our 11 med-surg hospitals
mdash Load balanced patients and ventilators to ensure eachhospital could manage capacity
bull MedSurg Care Group with daily huddles to assess real-time bedcapacity to load balance patients across 11 system hospitals
12
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
CKE RS ---------shy
Clinical Leadership amp Infection Control
JAMA The Journal of the American Medical Association
Why hospita W Hospital Mergers Improve Health Why hospital mergers may harm care quality Evidence Shows the Opposite February 11 2019 February 11 2019
The Risks to Patient Safety From Health System Expansions Susan Haas MD MSc Atul Gawande MD MPH Mark E Reynolds April 6 2018
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Do Mergers Lead to Better Quality
9
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Setting the Tone of Transparency in Leadership and Governance bull Gestation (2018 ndash 1 year pre-merger)
mdash Board composition without dominance of a single entity mdash 30 Design Team meetings with cross system representation
bull Launch (2019) mdash Senatorial model or representation for system quality P+T
meetings and Physician Advisory Council
bull Readiness for COVID 19 (2020) mdash Ahead of the game in preparedness
10
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull System Quality Forum relationships (CMOs CNOs quality directors case managers) facilitated system planning and response
bull Incorporated surrounding community hospitals in our huddles bull Our orthopedic specialty hospital repurposed to a medical and
psych hospital to accept COVID negative patients from other BILH hospitals (100+ admissions) to make room for COVID + patients
11
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull A Virtual Transfer Center was incorporated to manage access across system
bull Critical Care Group formed composed of ICU leaders of our 3tertiary care hospitals
mdash Twice-daily huddles to assess real-time ICU bed andventilator supply across our 11 med-surg hospitals
mdash Load balanced patients and ventilators to ensure eachhospital could manage capacity
bull MedSurg Care Group with daily huddles to assess real-time bedcapacity to load balance patients across 11 system hospitals
12
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Setting the Tone of Transparency in Leadership and Governance bull Gestation (2018 ndash 1 year pre-merger)
mdash Board composition without dominance of a single entity mdash 30 Design Team meetings with cross system representation
bull Launch (2019) mdash Senatorial model or representation for system quality P+T
meetings and Physician Advisory Council
bull Readiness for COVID 19 (2020) mdash Ahead of the game in preparedness
10
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull System Quality Forum relationships (CMOs CNOs quality directors case managers) facilitated system planning and response
bull Incorporated surrounding community hospitals in our huddles bull Our orthopedic specialty hospital repurposed to a medical and
psych hospital to accept COVID negative patients from other BILH hospitals (100+ admissions) to make room for COVID + patients
11
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull A Virtual Transfer Center was incorporated to manage access across system
bull Critical Care Group formed composed of ICU leaders of our 3tertiary care hospitals
mdash Twice-daily huddles to assess real-time ICU bed andventilator supply across our 11 med-surg hospitals
mdash Load balanced patients and ventilators to ensure eachhospital could manage capacity
bull MedSurg Care Group with daily huddles to assess real-time bedcapacity to load balance patients across 11 system hospitals
12
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull System Quality Forum relationships (CMOs CNOs quality directors case managers) facilitated system planning and response
bull Incorporated surrounding community hospitals in our huddles bull Our orthopedic specialty hospital repurposed to a medical and
psych hospital to accept COVID negative patients from other BILH hospitals (100+ admissions) to make room for COVID + patients
11
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull A Virtual Transfer Center was incorporated to manage access across system
bull Critical Care Group formed composed of ICU leaders of our 3tertiary care hospitals
mdash Twice-daily huddles to assess real-time ICU bed andventilator supply across our 11 med-surg hospitals
mdash Load balanced patients and ventilators to ensure eachhospital could manage capacity
bull MedSurg Care Group with daily huddles to assess real-time bedcapacity to load balance patients across 11 system hospitals
12
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
What has BILH Done to Avert a Patient Care Crisis
bull A Virtual Transfer Center was incorporated to manage access across system
bull Critical Care Group formed composed of ICU leaders of our 3tertiary care hospitals
mdash Twice-daily huddles to assess real-time ICU bed andventilator supply across our 11 med-surg hospitals
mdash Load balanced patients and ventilators to ensure eachhospital could manage capacity
bull MedSurg Care Group with daily huddles to assess real-time bedcapacity to load balance patients across 11 system hospitals
12
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program 1 Distraction distraction distraction 2 Interrupt cadence of quality amp safety meetings 3 Leaders at every level change messaging 4 Staff redeployment to unfamiliar roles responsibilities
and locations 5 New disease new treatments prone to new errors 6 Furloughs staff reductions from quality amp safety staff 7 Finances become burning platform 8 Withdrawal of external regulatory CMS and commercial
risk patient care and patient experience measures
13
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
Governance Leadership of Quality Confronting Realities and Creating Tension for Change A self-assessment tool can help health care boards address barriers to effective quality oversight
By Jim Conway
The role of hospital managers in quality and patient safety a systematic review Parand A Dopson s Renz A Vincent C BMJ Open 20144e005055
Improving patient care through leadership engagement with frontline staff a Department of Veterans Affairs case study
Singer SJ Rivard PE Hayes JE Shokeen P Gaba D Rosen A Jt Comm J Qual Patient Saf 201339349-360
-ASPR ANT bull lCat rtbull ~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership and Management The Performance ldquoTrifectardquo
14
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Mark Jarrett MD MBA Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)
UnclassifiedFor Public Use
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
The Imperative for Leadership Zero to Sixty in 6 Weeks
bull First COVID-19 case admitted to a Northwell hospitalon March 6
bull Peak April 8 3500+ COVID inpatients with over 800on ventilators
bull 2600 inpatient COVID deaths in 6 weeks ndash ldquonormalrdquo400
bull Current 780 inpatients and only 16 admissions perday
16
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leadership in the COVID-19 Crisis
bull HICS initiation is mandatory bull Partnership of clinical and administrative leadership bull Succession planning 2 levels down bull Data driven
17
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Important Aspects of Work Force Safety
bull Guidelines are a minimum bull Staff safety is crucial bull Standardization bull Patient safety must not be forgotten- reduces spread
18
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Workforce Safety Concerns
bull PPE All 3 phases- mitigation recovery and resurgence
bull Cohorting negative pressure rooms and diagnostic testing
bull Return to work bull Supply chain bull Psychological safety
19
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Communication
bull To other leaders bull To management bull Staff ndash most important bull Public and news media
20
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Walk the Walk
bull Visit your sites bull Follow the rules BUT donrsquot be afraid to change them
21
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Tracey Moffatt RN MHA System Chief Nursing OfficerSystem VP Quality Ochsner Health (Louisiana)
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
I I I I I I I I~ ___ __ ____ _ __ __ _ ___ __
33 320 330 47 414 428 Today JuneJuly
Patients Zero 431 854 973 680 378 150 GNO 300 599 642 639 226 60
ASPR TR AC IE ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Leading through Rapid Cycle Change in Unprecedented Times As executive leaders in healthcare we are all leading through change every day but during the peak phase of this pandemic the New Orleans ldquohot spotrdquo proved to be the biggest test to our leadership careers
How do you inspire confidence and resilience in a time of so much uncertainty
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You bull Plan
ndash Listen to a trusted group of clinicians and gain situational awareness
ndash Decide on top priorities patients staff equipment space
ndash Assemble the right teams of people bull Do
ndash Act quickly on the highest priority issues as possible
ndash Quickly define and redefine the ldquorulesrdquo of behavior
ndash Communicate actions to EVERYONE as frequently as needed
bull Check ndash Measure and analyze as much data
as you can about patterns and trends
ndash Predict ndash Watch for innovation
bull Act Continue to respond to what the people and the data tell you ndash How can we make your job easier
Safer ndash Abandon ldquoold thinkingrdquo and get
really creative
24
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Connect
bull Staffing is STILL the biggest challenge (and always will be)but abandon traditional thinking
bull Protect your most important element focus on staff safety bull Donrsquot sound like a ldquopoliticianrdquo ndash Acknowledge the fear
anxiety and frustration ndash Show your face (not literally) ndash Emote ndash vulnerability = courage ndash Talk to staff in small groups
bull Itrsquos a team sport ndash evaluate how to use everyone
25
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Resilience ndash More than an Ability to ldquoBounce Backrdquo
bull A human factors concept ndash the impact on patient andstaff safety
bull Harness our inner strength bull How can organizations help staff ndash Find meaning in every dayshift ndash Learn from experience ndash Remain hopeful ndash see past the current challenge ndash Self careteam care ndash Give in and be caught
26
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
TRACIE HEALTHCARE EMERGENCY PREPAREDNESS
INFORMATION GATEWAY
ASPR ASSISTANT SECRETARY ~-OR
PREPAREDNES S AND RESPONSE
Rollin (Terry) Fairbanks MD MS Vice President Quality and Safety MedStar Health (MarylandWashington DC) Founding Director National Center for Human Factors in Healthcare
UnclassifiedFor Public Use
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
ston
ASPR ANT bulllCatrtbull~ ~obull HUtTHCAH h oUGt NCT HthHONt~~ UIPAUDgt1111 ~ic UfPO~H INfORMATIO N GATEWAY
MedStar Health 10 Hospitals (DC Baltimore State of Maryland) 300 Ambulatory Sites 31000 associates 5500 physicians 8400 nurses 5M outpatient visits year 488000 ED visits year 175000 inpatient amp Observation admits year $6B Revenue (non profit) 110k Covered LivesInsured 1100 Residents amp Fellows Academic Health System Georgetown Partnership Top 15 in NIH research dollars
28
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
-
how we treat people High Reliability Organization
Five Common Principles of High Reliability Organizations (HROs)
MedSta r Health
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Relevant Guiding Principles
Early SUOnotification
Care for the patientfamily
Care for the caregivers
Initiate open communication
Early systems focused learning
Education
Advancing Health
29
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
Areas of Focus
-
Applied Research
bull Grants and contracts from government foundations and industry
bull Fublicat1ons presentations intervent ions pol icy recommendat ions
ID Usability Services
bull Medical devices
bull D1 g1tal health
-
Safety I ntegrat1on
bull Safety consults
bull Se nous safety event reviews
-
Education and Outreach
bull Georgetown Univers ity Medical Schoo l Course
bull Workshops talks and t rain ings
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfORMATIO N GATEWAY
National Center for Human Factors in Healthcare
Multidisciplinary approach - Human factors - Medicine - Engineering - Computer Science - Psychology
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
hospita l using mobile lab to train as many physicians as possible to use ventilators
by Lisa Fle-tdier ABO I Hidiiy April 10th 2020
ledSwr mobi~ sfmulati~ labqigt-(lp
III a El
WASH INGTON (ABC) - While there may be a short supply of vent ilators
across the country one DC hospital group is making sure theres no
shortage of doctors who know how to use them
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H I NfOR MATIO N GATEWAY
Preparation Started January 22
bull System Calls Started in January bull Increased Capacity Surge Planning ndash ICU beds 2x ndash Negative Pressure rooms 7x
bull Acquired diverse lab platforms bull Prepared Telehealth bull Planned Training bull Formed Command Groups ndash (Did not activate command center)
31
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
-d~- UJYIDl9 Tt d1lth(lgtltgtlao1lo10thc1 nI tltfltgt1Ltilfolt St Mo t f~I
D
March 8 CDC announces community spread
MedStar Heath tests first patient
March 18 All non-critical elective visits postponed
January 22 First MedStar Health Memo January 29
1s MedStar Health Coordination Call
March 5 First case
in Maryland
March 7 1st DC case was admitted to MedStar Georgetown
March 11 Outpatient testing 5 day
TAT
March 17 Elective
procedures cancelled
across MedStar Health
March 19 Started in-house testing
March 22 No hospital visitors
1 ambulatory visitor
March 24 Associates Mask in
Clinical Areas
March 20 Video Visit roll-out begins
March 27 Telehealth roll-out
completed
Occupational Health hotline opened
April 1 PPE
conservation pilots
announced
April 15 Battelle decon-
tamination partnership
April 29 Universal masking
May 1 1000th patient
discharged
May 18 Reopening strategy announced
MedStar Healthrsquos COVID-19 Response Timeline
March 16 Daily system leadership calls start
May 4 peak (524 COVID+ 648 Isolation)
UnclassifiedFor Public Use 32
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
COVID Command Teams Formed bull PPE amp Clinical Operations bull Infection Prevention bull Nursing Practice Lead bull Clinical Advisory Groups bull EHR Lead bull Data Analytics amp Reports bull Emergency Preparedness bull COVID Results Callback bull Physician Redeployment bull Nursing Redeployment bull Occupational Health bull Environmental Safety
bull Human Resources bull Performance Improvement bull Supply Chain bull Telehealth bull MedStar Triage OfficerMTO (Surge) bull Respiratory Therapy bull Pharmacy Lead bull Operational Communications and
Clinical Messaging bull Laboratory amp Laboratory Constraint
Management
Bolded items Human Factors influence
33
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
Telehealth in FY20 Jul Feb Apr
2019 2020 2020
1865 3175 83726 Monthly Telehealth Encounters
23 77 All MedStar sites offering telehealth services
115 162 3812 MedStar providers on telehealth platforms
13 18 Dozens Active MedStar telehealth programs
na 5 Many Newscaling MedStar telehealth programs (Q3-4 FY2020)
A SPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Telehealth Being Prepared for the Unexpected
Investments in Innovation and Telehealth provided the foundation
Telehealth Team 10 Pre-COVID19 250+ COVID19
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use
- MedStar Video Visit Executive Dashboard (Data through Saturday May 23 2020) MedSra r Hea I th A scheduled video visit between a paHent and their medical provider In lieu of an In-person appointment
Video Visit Volume
19991 Oaily eVlsit Volume wilh 5--Day Moving Average
VldeoV1$1lI Wt-cloft1ty 17
138959 Video Vists
S1nce MRrth 23
Video Visit Prov ider Utilization
Total Hours of Video Visits
1967 ~ Pr~s
WH~of cn~nabull
- WeekQfttcly 17 Apil 19 )
Apnl 26 5
3082 Mayoo 2
Total ProrwndH5 MaylO Since Maren tJ
May 17 bull 2
Video Visit Patient Experience
Video Visit Star Ratings April 151- Aprll 26 My03
J Avg Aulorm 47 47 47 l bullR_ 6673 6849 7074
j _
49 49 49 R l itR-p(ln1J1 6580 6743 6BlO
Miy 10 Aby 17
47 47
6914 6716
49 49
8606 8647
PlOd~9d by MTJC Oatii amp MiJytcs I MTICDW D1ti1 S-OUr~e BlueS1rearn Hcalh Oala I Vbullnion 1 03
Weekly Video Visit Volume
Week of
Video Visit Volume by Specialty (Top 10 - Current week)
SpltKialty
Aplil 19
April 26
M11y03
MJY 10
Moy 17
AII Wub
47
49321
49
48586
18569 amp 11
19446 5
W238 4
20060 r 1
19991 bull O-
4903
5192
528J
5Jll8
5399
lnlernal Medicine FNnlY Practice
~~~~ira1JtSeaS0 Psydl lry 1=11rnly M$dllIl8 lnlMll$1 =~=1 end Melaboli$111
Podialtics
Provider Video Visit Utlllzation by Specialty (Top o - Current Week)
Video Visit Duration
0011 45 9 00113 1 __ (hhmmss)
MedI1n VtsK Duration ~ oo-oa38 S-wetkly17 3e
a~ ooos45 001203 ~ 000454 0002middots3
(hhmmss) 000000 McdlanVd40uratKltI
Since Mtrcll 23 23 6 Mii~ 18
ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH hoUGpoundNC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATION GATEWAY
Data Visualization amp Workflow by Human Factors Group
35
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
symptomatic patients Use t he fo llowing t o determine if COVID-19 t esting is ind ica t ed
At least two flu-like symptoms (Myalgias Headache Chills Sore Throat)
OR Any One Fever OR Newworsened coughtrouble breathing OR Sudden loss of tastesmell OR GI symptoms (in children)
Asymptomatic Testing Guidelines are found on next page 1
Test for COVID-19 GREEN)
Patients requiring hospital ization
Patients wh o could increase risk of
community spread including
bull Livi ng in a grou p faci lity (shelter
nursi ng home cor rections faci lity or
other institution)
bull Healthcare workers public safety
workers (EMS fire po lice)
bull DOH-designated e ssentia l employees
(specifi c t o state)3
bull Receivi ng in-center treat ment
(dialysis chemotherapy)
Refer all non-hospitalized Med Star
Health associates to Occupational
Health (844) 354-3705 for testing
Testing MAY BE Indicated
Discretionarybull Testing When
Appropriate (YELLOW
Test the following patients if it wi ll
help gu ide cl inica l management
bull Patients wit h worsening respiratory
symptoms
bull Patients un der 1 o r over 65 yo
bull Patients wit h underlying medica l
conditio ns (chronic lung d isease
diabetes mellitus
immunosu ppression cardiovascular
disease)
bull Patients who are pregnant
Self-quarantine can be advised as an
equivalent measure if testing supplies
are limited
Do NOT Test for COVID-19
RED)
When patient does not meet criteria for
t esting listed in GREEN and clinician
does not feel testi ng is warranted in t he
YELLOW zone to guide cl inical care and
t esting does not meet the
Asymptomatic Testing gu idelines then
do NOT test
Please provide verbal education to the
patie nt and provide patient with the
Viral Respiratory Illness Home Care
Instructions document
Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
UnclassifiedFor Public Use 36
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
- ~
MedStar Health COVID-19 Personal Protective Equipment (PPE) for HOSPITAL Locations Information valid as of 3 3020
Hospital
Patients Wit h sym ptoms includi ng fever cough shortness of brea t h or ot her signs of resp ira t ory il lness w hen t hey are not in
the ir pat ie nt room
Surgical Mask
Visitors Visitors to COVI D-19 Confirmed Pat ients Drop let amp Contact or COVID-19 PUis must be approved by the hosp ita ls VPMA If approved see necessary PPE Visitors may not be in th e room during COV ID-19 test ing
Associates Assoc ia tes in cl inica l care area where
Physicians Residents and
Fellows
pat ients are NOT PUis o r COV ID + (commo n areas ha llways nonshyPUICOVID-19 +)
Assoc ia tes interact ing and car ing for a PU I or COV ID-19+ pat ient who is wea ri ng a su rgical facemask for t he ent ire interact io n (outside the patient room)
Procedura list s performing aerosol genera t ing procedures (AGPs) ON AU PATIENTS including (endoscopy transesophageal echocardiograms flexible laryngoscopy and bronchoscopy)
Caring for a PUI o r COV ID-19 + pat ient
who is not wearing a mask (in the patient room)
Precau t ions
Airborne amp Contact
Precautions
Negat ive pressure room when
ava ila ble
This guidance should be used for care of patients with suspected or confirmed COVID-19
Surgica l mask Isolatio n gown
Face s hie ld (eye protect ion) Gloves
bull Surg ical Mask
bull Surg ical Mask
N95 respirator (DURING AU AGPs) Isola tion gown Face shie lds or goggles (eye protection) Gloves
N95 respirator (DURING AU CARE) Isolation gown Face shields or goggles (eye protect io n) Gloves
----
N 95 Mask
Use of Summary Graphics
UnclassifiedFor Public Use 37
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
Associate safety and wellbeing
PPE Guidance
Occupational Health Resources
HR Resources
Wellbeing
Remote Access Technologies (VPN)
Nursing
Pattent Care gt
Nursing Guidelines and Documentation gt
Caring for You gt
Patient care
Clinical Guidelines
Ordering Testing and Reporting Results
Scheduling and Front Desk
Ambulatory Reopening Guidance (Virginia ONLY
Discharge and Transfer
Video Visits
Operations
Infection Prevention and Isolation Practices gt
Visitor Policies and Resources gt
Printable S1gnage gt
Elective Procedures gt
Over 150 linked resources
-Mbull r I
COVID-19 patient care amp associate safety resources
--middot-==--- middot=bull----COWD-n bull _ - a-c -~---
0 -~ ~shymiddot-shy~ o=--1
_ __ ___
see
14frac14plusmn1amp9- yen5 - dftiM
Protocols amp Resources
wwwMedStarHealthorgCOVID19resources
UnclassifiedFor Public Use
38
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
Clinical Guidelines v
EM Critical Care lo 1
gt
__________Imaging Radiology
Respiratory Therapy
Pharmacy Medication Management gt
Obstetrics and Neonatology gt
Pediatrics gt
Hospital Medicine gt
Surgical Guidelines gt
Ambulatory Care gt
Isolation Guidelines gt
Behavioral Health gt
EM Critical Care v
New Anticoagu lation in COVID-19 Positive Patients
Updated Clinical Guide for Initial Assessment Testing and
Triage for COVID-19
Clinical Gui de for Intubation
Clinical Guide for Management of Mild to Moderate
Hypoxemia due to COVID-19 on the Floors
Clinical Guide for Management of Moderate to Severe
Hypoxemia due to COVID-19 with HFNC
Clinical Guide for Mechanical Venti lation of COVID-1 9
CODE Blue Response ALL PATIENTS During COVID-19
Pandemic
Consent for Limited Trial of ECMO
Critica l Care Proning Protocol
ECMO Al location During COVID-19
Sedation Pain Paralysis Guidance for Ventilated COVID
Patients
UnclassifiedFor Public Use 39
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Question amp Answer
40
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-
UnclassifiedFor Public Use -ASPR ANT bulllCatrtbull~ ~obull HUtTHCtH h oUGpound NC1 HpoundhHONpound~~ UIPAUDgt1111 ~NC UfPO~H INfORMATIO N GATEWAY
Contact Us
asprtraciehhsgov 1-844-5-TRACIE askasprtraciehhsgov
41
- Developing a Healthcare Coalition Pediatric Surge Annex
- ASPR TRACIE Three Domains
- Resources
- Moderator-Meghan Treber MS ASPR TRACIE13
- Erin Fowler MS BSN13Senior Advisor Office of Global Health13Health Resources and Services Administration (HRSA)
- Jeff Brady MD MPH13Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality (AHRQ)13UnclassifiedFor Public Use
- Richard Nesto MD13Chief Medical Officer Beth Israel Lahey Health (Massachusetts) 13UnclassifiedFor Public Use
- About Beth Israel Lahey Health (BILH)
- Do Mergers Lead to Better Quality
- Setting the Tone of Transparency in Leadership and Governance
- What has BILH Done to Avert a Patient Care Crisis
- What has BILH Done to Avert a Patient Care Crisis
- How the COVID-19 Pandemic Undermines Progress in a Systemrsquos Quality amp Safety Program
- Leadership and Management The Performance ldquoTrifectardquo
- Mark Jarrett MD MBA13Senior VP and Chief Quality Officer Deputy Chief Medical Officer Northwell Health (New York)13
- The Imperative for Leadership Zero to Sixty in 6 Weeks
- Leadership in the COVID-19 Crisis
- Important Aspects of Work Force Safety
- Workforce Safety Concerns
- Communication
- Walk the Walk
- Tracey Moffatt RN MHA13System Chief Nursing OfficerSystem VP Quality13Ochsner Health (Louisiana) 13UnclassifiedFor Public Use
- Leading through Rapid Cycle Change in Unprecedented Times
- Solve Whatrsquos RighthellipAnd Whatrsquos Right in Front of You
- Connect
- Resilience ndash More than an Ability to ldquoBounce Backrdquo
- Rollin (Terry) Fairbanks MD MS13Vice President Quality and Safety MedStar Health (MarylandWashington DC)13Founding Director National Center for Human Factors in Healthcare13
- MedStar Health
- Relevant Guiding Principles
- National Center for Human Factors in Healthcare
- Preparation Started January 22
- MedStar Healthrsquos COVID-19 Response Timeline13
- COVID Command Teams Formed
- Telehealth Being Prepared for the Unexpected
- Data Visualization amp Workflow by Human Factors Group
- Testing Algorithm Visual Design ldquoRedYellowGreenrdquo
- Use of Summary Graphics
- Protocols amp Resources
- Slide Number 39
- Question amp Answer
- Contact Us
-