03.26.2020 | System Support Team

ED Overflow TentsToolkit

1

Contents

Site Preparation

• Overview

• Roles & Responsibilities

• Facility Layout Example

• Preparation teams

Process preparation

• Process Preparation checklist

Support• Communication

• Questions & Contacts

Appendix• COVID-19 Resources

• Workflow designs

• Sorting Area

• ED Overflow tent

• Emergency Room integration

• Registration Workflow (Cerner & Epic)

Process & Workflows

ED Overflow Tents: OverviewPurpose/Scope

1. Address the surge of volume in Mildly Ill and Worried Well to ED2. Protect our patients, team members and clinicians and conserve PPE3. Priority approach based on Volume, Space and Potential Surge4. Anticipatory planning for future contingencies in patient acuity

Population

• Referrals from Virtual Care and Walk-Ins

Tent Operations• Mildly Ill and Worried Well are seen for MSE within the tent• Any critical or potential admissions continue with normal ED visit

ED Overflow Tents: Overview

Patient

Arrives

COVID-19 Risk

Screening

Likely Discharge

Secondary COVID-19 Screening

Medical Screening

Exam

Remote Registration

Evaluate & Treat

Applicable waiting

area

Likely Admission

Triage

Triage Tent

Emergency Room

ED Overflow Tent

Roles and Responsibilities

• High-level clinical & patient workflows

• Minimum staffing recommendations

• Collaboration with sites for provider staffing

• Provide ED Overflow tent

• Initial Supplies delivered

• Standard Signage Package

• Facility & IT equipment setup

• All HIT Equipment - printers, workstations, phones (based on availability)

• Support Staffing (based on system labor command center availability)

• HIT builds

• Opportunity to utilize EmOpti or AmWell

System Incident Command

• Resource site-based staffing. If needed, leverage System Labor Command Center

• Collaboration with the system for APC/Physician staffing

• Pharmacy & Supply Replenishment

• Evacuation Plan

• Escalation Plan

• Hours of operation (based on volume)

• Determine PUI Cohort Rooms & Waiting rooms within the ED

• Determine site-specific cueing process from waiting area within ED Overflow tent to exam bays

• Complete dry run with Facilities & IT

• Integrate virtual health into workflows

• Ensure staff have received proper training

• Execute tent EVS cleaning guidelines

• Follow site language services

• Determine Final Go-Live Date

• Participate in Post Go-Live Debriefing Meeting

Site Incident Command/ED Leaders

Facility Layout ExamplesTriage tent

• Small tent sourced from Site Incident Command decontam. Supply (if available)

• Locate as proximate to ED entry as possible

• Site will need to determine cueing process in coordination with site security

ED Overflow tent

• Mobile workstations & designated printers within workspace & phone capabilities.

• Nearby restrooms (staff vs. pt)• Supply/equipment stations.• Sanitizer & wipes within exam room.• Patient waiting space within ED Overflow tent

• Site will need to determine cueing process

Site Preparation Team

Site Leadership Team

• Site Incident Command Team

• ED Medical Director

• ED Nursing Director

• ED Nursing Manager

• Design & Construction Lead

Additional Ad-Hoc Departments

• Facilities

• Security

• Infection Prevention

• Clinical Informatics

• IT

• Supply Chain

• EVS

• Patient Access

• Interpreter Services

1. Clean and disinfect:•Recliner•Reusable equipment (i.e. VS cart, stethoscope, etc.)•Stool•Handle on COW and PPE Cart•Computer keyboard

2. Remove waste from bay when garbage can is full and place in designated area

Cleaning Guidelines

Rationale:• Environmental surfaces and medical equipment must be cleaned to prevent the transmission of infectious pathogens• PDI Sani Cloth has EPA claim for emerging viral pathogen• Clorox Hydrogen Peroxide has EPA claim for emerging viral pathogen

Nursing / PCT Staff(stationed inside of tents)

Cleaning Best Practices:IL: Use Purple Top with 2-minute contact "wet" time

WI: Clorox Hydrogen Peroxide with 1-minute contact “wet” time

Triage TentTips

• One of two screening team members must be an RN.

• Ensure you are actively watching for patients to arrive.

• Please ensure sufficient team members are staffed to ensure appropriate crowd control.

• Follow the standard tips for PPE -https://www.advocatehealth.com/covid-19-info/

• Risk screening can occur either in a sorting tent, or in the ED vestibule.

• Risk screening is anticipated to be less than a two-minute process.

• Instruct patient to follow all social distancing guidelines.

Description

• Risk Screening team should consist of 2 team members (at a minimum) who are actively watching for patients to arrive.

• Patients should be screened either in the triage tent, or the vestibule to the Emergency Department.

• Screening should occur prior to the patient entering either the overflow tent or the facility.

• Patient PulseOx should be taken prior to leaving the Triage tent

• Patient should be given mask (per current protocols).

• Risk Screening determines if patient is:

• COVID-19 risk > anticipated home discharge

• Send to ED Overflow tent

• COVID-19 risk > anticipated admission

• Send to ED COVID-19 Patient under Investigation cohort area

• Non-COVID-19 risk

• Send to ED through normal triage route.

COVID-19 Risk Screening

Triage tent is intended quickly to sort patients into appropriate clinical

workspace

Standard Work

1

2

3

Tent Setup

*Place mask on patient after checking pulse ox and sending them to ED Overflow Tent*

ED Overflow TentTips

• Ensure waiting area is set up to ensure social distancing guidelines are followed (as indicated on your site-specific layout).

• Ensure waiting area support is clinical and trained on PPE guidelines

• Security may be necessary as volumes increase.

• https://www.advocatehealth.com/covid-19-info/

• Phone number for patient to contact is issued in triage tent.

• Please contact your site patient access director with questions.

Description

• Patients who risk screened positive as anticipated discharge should enter the waiting area within the ED overflow tent.

• All sites should staff one individual in the waiting area to support the cueing process.

• As volumes increase, additional cueing staff may be necessary to manage overflow volume.

• Patients will be placed into an exam bay once available.

• Registration process is completed by remote PSR , label is printed, and bracelet is banded per the site-specific cue process.

• Phone number will be provided by site patient access leaders.

CompleteRegistration

Overflow Waiting Area

Standard Work

ED Overflow TentTips

• If using centralized printers, ensure the correct patient is receiving their discharge paperwork.

• Ensuring ED staff responds quickly ensures the screened COVID-19 positive patient does not leave the assigned PUI area.

• Maintain social distancing.

Description

• Print discharge instructions.

• Educate patient as needed.

• Ensure relevant prescriptions are discussed.

• Send Patient home.

• Escort patient to designated ED COVID-19 PUI area.

• Escort should alert ED staff of patient’s arrival.

• Follow standard admission process.

Anticipated Hospital Admission

Not Require Testing, Discharge Home

Standard Work

Instruct patient to follow all social distancing guidelines

*Place mask on patient after checking pulse ox and sending them to ED Overflow Tent*

SupportTips

• Daily deployment huddles will address lessons learned and on-going issues.

Description

• Site level communication is critical to ensuring successful implementation while making any necessary adaptations.

• Site leaders should round on the Triage tent, ED overflow tent, and ED admission processes to offer guidance if adjustments need to be made.

• Site level incident-command communication with ED leadership is critical.

• The ED overflow tent planning committee has established these protocols and workflows.

• Workflow adaptations and concerns should be funneled to ED leadership with the goal of implementation and resolution.

• Workflow concerns that are unable to be resolved should partner with site incident-command.

Daily Deployment Huddle

Communication

Standard Work

Include updates as a part of safety huddle

Security

• The Public Safety Department and parking team monitor the ED and ED Overflow for security concerns.

• The Advocate Security Command Center (ASCC) operates 24/7 and monitors the weather. The ASCC will provide notifications to the Incident Command and ED leadership if dangerous conditions develop.

Process PreparationAction

Identify & assemble Build Site Preparation Team

Review Roles, Responsibilities, and Standard work contained in the presentation.

Follow the cleaning process and ensure PPE Guidelines

Complete deployment meeting

Team Member Training

Implement ED tent overflow program.

Plan and Execute simulation.

Implement changes and adaptations as needed.

Debrief huddle post-implementation.

Summary

Key changes

• Exterior screening for all sites.

• COVID-19 screened positive patients (those anticipated to discharge home), receive care in exterior tent.

• Registration process deployed.

Next Steps

• Tool-kit sent out to site contacts.

• Key documents published on COVID-19 website.

• Site level deployment meeting with simulation.

• Daily Deployment Huddle across sites.

Outcome

• Safe care for patients with varying needs.

• Safety for team members and physicians.

• ED resources available for emergent needs.

Appendix

COVID-19 ResourcesDescription/substeps

• Informational resources and corresponding toolkits are readily available to answer COVID-19 questions.

• For the latest information, click the link below:

https://www.advocatehealth.c

om/covid-19-info/

Team Member & Physician Information Center

Review the COVID-19 information center as

updates are frequently

made

Standard Work

Workflow design & Staffing

• (1) ED RN

• (1) PCT

Triage Tent

ED Overflow Tent

• 1:4 RN to patient Ratio

• (1) PCT

• 10:1 APC

Number of exam rooms may vary by tent/site

Place mask on patient after checking pulse ox and sending them to ED Overflow Tent.

Place mask on patient after checking pulse ox and sending

them to ED Overflow Tent.