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Metro North Patient Services COVID-19 Response Plan 14 August 2020

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Published by the State of Queensland (Metro North Hospital and Health Service), August 2020 [IBNN or ISBN if needed]

This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au © State of Queensland (Metro North Hospital and Health Service) 1019 You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Metro North Hospital and Health Service). For more information, contact: Metro North Emergency Management and Business Continuity, Metro North Hospital and Health Service, Block 7, RBWH, Herston QLD 4029, email MN-EmergencyManagement@health.qld.gov.au, phone 07 3646 3743. An electronic version of this document is available at https://metronorth.health.qld.gov.au/extranet/coronavirus

Disclaimer:

The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information.

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Contents Contents ................................................................................................................................................. 3

Abbreviations ......................................................................................................................................... 4

1 Introduction ............................................................................................................................ 5 1.1 Situation ................................................................................................................................... 5 1.2 Purpose .................................................................................................................................... 5 1.3 Authority ................................................................................................................................... 5 1.4 Scope ....................................................................................................................................... 6 1.5 Assumptions ............................................................................................................................. 6

2 Pandemic phases ................................................................................................................... 6 2.1 National and State policy decisions ..................................................................................... 7

3 Partners and stakeholders .................................................................................................... 7

4 Roles Responsibilities ........................................................................................................... 8

5 Activation ................................................................................................................................ 8 5.1 Command and Communication ................................................................................................ 8

6 Response ................................................................................................................................ 8 6.1 Triggers and response activity overview .................................................................................. 8 6.2 Tier 0: Prevent local transmission and prepare ....................................................................... 9 6.3 Tier 1: Limited community transmission ................................................................................. 10 6.4 Tier 2: Moderate community transmission ............................................................................. 10 6.5 Tier 3: Significant community transmission ............................................................................ 12 6.5.1 PPE for staff ........................................................................................................................... 12 6.5.2 PPE stockpiles and consumables .......................................................................................... 13 6.5.3 Operational support ................................................................................................................ 13 6.5.4 Human resources ................................................................................................................... 13 6.5.5 Financial management ........................................................................................................... 16 6.6 Control .................................................................................................................................... 16 6.7 Recover .................................................................................................................................. 16

Appendix 1: Patient Services COVID-19 Committee list .................................................................. 18

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Abbreviations AEFI Adverse Events Following Immunisation AHPCC Australian Health Protection Principle Committee BAU Business as Usual CE Chief Executive, Metro North Hospital and Health Service CHO Chief Health Officer CISS Community, Indigenous and Sub-acute Services DDC District Disaster Coordination (Queensland Police Service) DDMG District Disaster Management Group EMP Emergency Management Plan EOC Emergency Operations Centre ERP Emergency Response Plan GP General Practitioners HC Hospital Commander HEOC Metro North Hospital and Health Service Emergency Operations Centre HIU Health Improvement Unit HIC Health Incident Controller HLO Health Liaison Officer IAP Incident Action Plan ICT Information and Communication Technology ICU Intensive Care Unit ILI Influenza-like Illness IMS Incident Management System IMT Incident Management Team LDMG Local Disaster Management Group MN – EMC Metro North Emergency Management Committee MN – EMP Metro North Hospital and Health Service Emergency Management Plan MN - EMU Metro North Emergency Management Unit MN – ERP Metro North Hospital and Health Service Emergency Response Plan MN – IMT Metro North Hospital and Health Service Incident Management Team MN Metro North MNHHS Metro North Hospital and Health Service MNPHU Metro North Public Health Unit MOU Memorandum of Understanding NDIS National Disability Insurance Scheme NDRRA Natural Disaster Relief and Recovery Arrangements NMS National Medical Stockpile PACH Patient Access and Coordination Hub PCR Polymerase chain reaction PPE Personal Protective Equipment QAS Queensland Ambulance Service QDMA Queensland Disaster Management Arrangements QHIMS Queensland Health Incident Management System RBWH Royal Brisbane and Women’s Hospital SET Senior Executive Team (Metro North Hospital and Health Service) SHECC State Health Emergency Coordination Centre SITREP Situation Report SMEAC Situation, Mission, Execution, Administration, Communication TPCH The Prince Charles Hospital

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1 Introduction

1.1 Situation In December 2019, China reported cases of viral pneumonia caused by a previously unknown pathogen that emerged in Wuhan, China. The pathogen was identified as a novel (new) coronavirus (recently named Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)), which is closely related genetically to the virus that caused the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS). SAR-CoV-2 causes the illness now known as Coronavirus disease (COVID-19). Currently, there is no specific treatment, vaccine or antiviral against new virus.

1.2 Purpose The purpose of this pandemic response plan is to ensure continuity of health services and minimise the community impact within Metro North Hospital and Health Service (Metro North HHS) of COVID-19, and in particular outline the response plan for Patient Services (PS). The strategic objectives of this plan are to:

• minimise risk to staff responding to COVID-19 through appropriate training, personal protective equipment (PPE) and infection control practices

• minimise the transmission of COVID-19 within the Metro North HHS (Metro North HHS) community and within healthcare settings through proactive identification and testing, effective infection control activities, and community messaging

• determine appropriate measures to increase capacity to meet demand during the pandemic

• ensure the HHS maintains its critical services continuity

• maximise the health outcomes of peoples with COVID-19.

1.3 Authority Nationally, the Biosecurity Act 2015 and the National Health Security Act 2007 authorises activities to prevent the introduction and spread of diseases in Australia and the exchange of public health surveillance information (including personal information) between state and territory government, the Australian Government and the World Health Organisation (WHO). The World Health Organisation (WHO) declared that outbreak of COVID-19 a Public Health Emergency of International Concern on 30 January 2020. The Queensland Department of Health declared a public health event of state significance under the Public Health Act 2005 on 22 February 2020. The issue of Public Health Agreements are issued by designated Emergency Officers (Environmental Health Officers) under this act. The issuance of Detention Order by an Emergency Officer (Medical) (Public Health Physicians) is also under this Act. The Chief Health Officer (CHO) directed all health services to:

- Provide health staff to screen and conduct clinical assessment of passengers identified by Australian Border Force including the transfer of symptomatic persons to emergency departments for testing / treatment and/or supporting access to government provided accommodation where travellers are identified as not being able to isolate in the same location for 14 days.

- Via Public Health Units:

o Issue isolation agreements to travellers at points of entry who meet coronavirus case definition; suspect case definition or close contact case definition

o Provide information and guidance to general practitioners and the public regarding testing and isolation requirements

o Contact trace any persons who may have been in contact with confirmed cases o Support the clinical management of persons who are in isolation

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- Plan for new or expanded models of care (such as telehealth/hospital in the home, virtual fever clinics and treatment of chronic conditions at home)1.

The COVID-19 response within Metro North HHS is authorised by the Health Incident Controller (HIC) under the Metro North Emergency Management Plan. Each Directorate within Metro North HHS is required to develop their own individual pandemic response plan.

1.4 Scope This pandemic response plan covers the PS response to COVID-19 to ensure the continued delivery of critical clinical services to existing patients and the Metro North HHS community. This plan is supplementary to the Metro North HHS Response Plan which is updated weekly with any policy decisions.

1.5 Assumptions This plan was developed based on the following assumptions:

• the incubation period of COVID 19 is up to 14 days (in line with current WHO advice) • routes of transmission will be via large droplet or fomite route • telecommunication networks (or adequate redundancies) are operating • the Queensland Health ICT Network remains operational • support services (e.g. Australian Red Cross Blood Bank, eHealth, Health Support Queensland

(HSQ) (including linen and central pharmacy), Queensland Urban Utilities, Unity Water and ENERGEX) remain available albeit at potential reduced capacity.

• there will be impacts to Metro North HHS staffing.

2 Pandemic phases

Australian phase Description

ALERT OS3

A novel virus with pandemic potential causes severe disease in humans who have had contact with infected animals. There is no effective transmission between humans. Novel virus has not arrived in Australia.

DELAY OS4/OS5/OS6

Novel virus has not arrived in Australia. OS4 Small cluster of cases in one country overseas. OS5 Large cluster(s) of cases in only one or two countries overseas. OS6 Large cluster(s) of cases in more than two countries overseas.

CONTAIN AUS 6a - January 2020

Pandemic virus has arrived in Australia causing small number of cases and/or small number of clusters.

SUSTAIN AUS 6b – 25 March 2020

Pandemic virus is established in Australia and spreading in the community.

1 25 February 2020

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Australian phase Description

CONTROL AUS 6c Customised pandemic vaccine widely available and is beginning to bring the pandemic under control.

RECOVER AUS 6d Pandemic controlled in Australia but further waves may occur if the virus drifts and/or is re-imported into Australia.

Note 2008 Australian Phases version used over 2019.

2.1 National and State policy decisions Commonwealth restrictions

• International borders remain closed Queensland CHO Directions

• Aged Care Direction (No. 9) • Border Restrictions Direction (No. 12) • Hospital Visitors Direction (No. 6) • Movement and Gathering Direction (No. 2) • Point of Care Serology Tests Direction • Prescribing, Dispensing or Supply of Hydroxychloroquine Direction • Protecting Public Officials and Workers (Spitting, Coughing and Sneezing) Direction (No. 3) • Restricting Cruise Ships from Entering Queensland Waters Directions (No. 2) • Restriction on Businesses, Activities and Undertakings Direction (No. 5) • School and Early Childhood Service Exclusion Direction • Seasonal Workers Health Management Plans Direction • Self-isolation for Diagnosed Cases of COVID-19 Direction (No. 3) • Self-quarantine for Persons Arriving in Queensland From Overseas Direction (No. 5)

Overview of Metro North HHS Metro North HHS has a local population of over one million people (1,046,494 - 2019 preliminary estimated resident population), in an area stretching from the Brisbane River to north of Kilcoy. Clinical services are provided at The Royal Brisbane and Women’s (RBWH), The Prince Charles Hospital (TPCH) Redcliffe Hospital, Caboolture Hospitals, Kilcoy Hospital and at the Woodford Correctional Facility. Mental health, oral health, Indigenous health, subacute services, medical imaging and patient services are provided across many sites including hospitals, community health centres, residential and extended care facilities, and mobile service teams. Metro North HHS has a dedicated Public Health Unit. Patient services covers all facilities within Metro North HHS and includes:

• Patient support services • food services • protective services • administration and compliance.

3 Partners and stakeholders PS has a range of local partners and stakeholders who they will work with in deliver on this response plan and continue to provide high level healthcare to the local community. These partners and stakeholder include: • Queensland Police (Chair of Brisbane DDMG)  • Queensland Ambulance Service   • Group Linen Services • Queensland Government Air (Rotary Wing)

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4 Roles Responsibilities In line with the Queensland Health Pandemic Plan, the Department of Health leads the overall response to pandemic within Queensland and will coordinate and direct response requirements at a system level. Metro North will coordinate and lead the implementation of response requirements at an HHS level and will support Directorates. PS is responsible for local identification and operationalisation of their response plan.

5 Activation Metro North HHS has activated its Emergency Management Plan and its Health Emergency Operations Centre. Patient Services aligns with Metro North EOC and links in with Facility EOCs and IMTs.

5.1 Command and Communication All incident communication is to be via the Metro North Clinical Support Services Directorate EOC email account EOC-MNCSS@health.qld.gov.au and Metro North EOC.

6 Response

6.1 Triggers and response activity overview The PS Response Plan spans from Tier 0 through to Tier 3. Tier 4 and 5 are considered at a Metro North level only.

SUSTAIN -TIER1

SUSTAIN -TIER 0

SUSTAIN -TIER 2

SUSTAIN -TIER 3

SUSTAIN - TIER 4

SUSTAIN - TIER 5

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6.2 Tier 0: Prevent local transmission and prepare

Governance Personnel Fever Clinic ICU

IMT active Clinical Support Services EOC –

stood up

Identify staff available for additional shifts and overtime as required.

Engage with AWU and establish consultative environment

Initiate recruitment and training strategy in preparation for tier 2/3

Commence workforce location and availability modelling

Commence workforce work from home evaluations

NA NA

ED Inpatient COVID-19

NA Minimise movement of inpatients with confirmed or suspected COVID-19 within wards or across the hospital,

Meetings Training Service Operations Facility

Adhere to social distancing Virtual meetings where able Weekly PPE meetings Weekly Patient Services planning

meetings CSS EOC stood up

No restrictions – social distancing to be observed

PPE training for all staff Review yellow clean training and

workforce capability

Review equipment availability and order identified shortfalls relating to wear and tear and increase capacity as a result of staffing increases

Concierge at key entrances Security – maintain Cleaning - frequent touch point cleaning establish yellow clean surge teams Facility ensures at the point of

generation, linen used for a person suspected or confirmed to have COVID-19 infection should be placed in an alginate bag and then into an appropriate laundry receptacle.

Facility ensures COVID-19 confirmed or suspected all waste is disposed of as per clinical waste requirements.

Enhance traffic signage Food, linen and waste services –

use PPE in accordance with Queensland Health and Metro North guidance

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6.3 Tier 1: Limited community transmission

Governance Personnel Fever Clinic ICU

As per Tier zero plus weekly service line meetings

As per Tier zero plus

Identify staff available for additional shifts and overtime as required.

wipe down personal ipads/phones; wipe down hard surfaces

discourage congregation in tearooms and other shared spaces

As per Tier zero plus increase and/or relocate staff from

Patient Support Services and Protective Services

NA

ED Inpatient COVID-19 As per Tier zero plus

increase and/or relocate Patient

Support Services staff

As per Tier zero

Meetings Training Service Operations Facility As per Tier zero plus

Individual service line daily

COVID meetings Weekly Patient Services

management planning meetings

MNHHS PPE meeting

As per Tier zero

As per Tier zero plus Minimise staff movements across

wards and facilities Consider roles that can work

remotely Discourage congregation in tearooms

and other shared spaces Enact staff management plans Prepare PTU and cleaning staff to

align with patient care areas Remodel patient meal delivery

process to minimise potential for cross contamination regarding patient/staff exposure specific to aged care facilities

As per Tier zero plus

Enhance traffic signage and traffic support at established COVID clinics.

Enhanced security presence at all sites

6.4 Tier 2: Moderate community transmission Governance Personnel Fever Clinic ICU

As per Tier one As per Tier one plus: All staff to adhere to wearing of face

masks at work.

NA NA

ED Inpatient COVID-19

NA NA

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Meetings As per Teir one plus: Service Operations Facility

As per Tier one As per Tier one plus: All face to face training cancelled

As per Tier one plus: Enable cleaning and portage staff to

align with specific geographical locations within facilities

Enable Food Services staff to align with geographical locations within facilities

As per Tier one

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6.5 Tier 3: Significant community transmission Governance Personnel Fever Clinic ICU

As per Tier two As per Tier two plus: Engage and assist with redeployment

of employees

NA NA

ED Inpatient COVID-19

NA As per Tier two

Meetings Training Service Operations Facility

As per Tier two As per Tier two As per Tier two As per Tier two plus: Cleaning - Initiate HHS-wide

cleaning rapid response. Provide contract cleaners as required for security and food services.

Food Services - Engage contracted food suppliers to provide meals to MNHHS sites as required

Security - Surge up inhouse guards to enable increased presence at facilities and community sites

6.5.1 PPE for staff It is expected that Patient Services staff will comply with standard precautions in line with MN documented procedures, including hand hygiene (5 Moments) for all patients with respiratory infections. In addition:

• patients and staff should observe cough etiquette and respiratory hygiene • comply with transmission-based precautions for patients with suspected or confirmed COVID-19:

o contact and droplet precautions for routine care of patients o contact and airborne precautions for aerosol generating procedures

• if patient transfer outside the room is essential, the patient should wear a surgical mask during transfer and follow respiratory hygiene and cough etiquette.

For most inpatient contacts between healthcare staff and patients the following PPE is safe and appropriate and should be put on before entering the patient’s room. For hospitalised patients requiring frequent attendance by medical and nursing staff, a P2/N95 mask should be considered for prolonged or very close contact as per the guide for choosing PPE.

Droplet - Contact and Standard Precautions for Standard Care i.e.:

• surgical mask • long sleeve impermeable gown

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• gloves • protective eyewear / face shield

Airborne - Contact and Standard Precautions for aerosol-generating procedures (for example, taking respiratory specimens, suctioning, intubation, nebulisers), patients with significant respiratory illness, or prolonged exposure (i.e. > 15 minutes face-to-face contact or in same room for > 2 hours).

• negative pressure room where possible • P2 / N95 mask • long sleeve impermeable gown • gloves • protective eyewear / face shield.

6.5.2 PPE stockpiles and consumables Patient Services link into facilities for PPE supply. Local teams manage PPE stockpiles and clinical consumables to determine and ensure appropriate stock levels are available to support BAU as well as expected surges. The provision of PPE must focus foremost on staff but is also required for patients and visitors in certain circumstances. PPE appropriate for COVID-19 includes:

• disposable gloves, • long sleeve gowns, • goggles • surgical/N95 masks and • alcohol hand gel.

PPE is available and placed at the entrances/reception desks within all publicly accessible areas.

6.5.3 Operational support Environmental cleaning of patient care areas: Patient Services align with Metro North:

i.Cleaners should observe contact and droplet precautions signage ii. Environmental cleaning and disinfection of infection control areas will occur in line with current Queensland Health and Metro North HHS Guidelines ii. Frequently touched surfaces such as doorknobs, bedrails, tabletops, light switches, patient handsets in clinical areas and patient room should be cleaned

daily iii.Frequently touched surfaces such as doorknobs, bedrails, tabletops, light switches, patient handsets in non-clinical areas will be cleaned more frequently iii.Perform terminal cleaning of all surfaces (as above plus floor, ceiling, walls, blinds) after a patient is discharged iii.A combined cleaning and disinfection procedure should be used; this is either

• 2-step - detergent clean, followed by disinfectant; or • 2-in-1 step - using a product that has both cleaning and disinfectant properties. Any hospital-grade, TGA-listed disinfectant that is commonly used against norovirus is suitable, if used according to manufacturer’s instructions.

6.5.4 Human resources The health, safety and wellbeing of all healthcare workers is a priority for Metro North HHS. A staff management portfolio has been established which will manage and monitor the reallocation of staff, ensuring allocation to priority areas and matching of skill sets. A survey to identify staff able and willing to be reallocated has been conducted and distributed to the Directorates. Directorates staff management team/coordinator will manage staff within their Directorates and access Metro North team as required. A wellbeing strategy is being implemented with the aim to ensure staff feel supported and that their wellbeing is at the forefront of everything we do during the pandemic. A wellbeing executive has been appointed to oversee and manage staff wellbeing during this time. This strategy links staff to available resources and tools to assess and support their wellbeing. Patient Services has established a network of RUOK trained staff to support our employees.

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Staff management A range of strategies to ensure adequate workforce are available during the pandemic will be implemented in line with the tiered response including:

• new rostering models – respond to changes in facility workflows. • reassigning healthcare workers out of their usual work area • utilising healthcare students as assistants • reviewing scope of practice • increasing casual pools and temporary staff. • increasing hours of part time staff on voluntary basis • active leave management including absenteeism and fatigue • accelerated recruitment processes.

6.5.4.1 Managing ill workers Ill or quarantined workforce will be managed in line with the Queensland Health Human Resources Guidelines available on the intranet. Refer to section 7.2.1.1 for details on managing vulnerable workforce. Patient Services follow MN guidelines.

Leave, Returning and returning to work

Different leave types, either paid or unpaid, may be granted to employees directly affected by this event. Refer to the MNHHS COVID-19 Virus Pandemic Factsheet for information regarding specific leave options.

Quarantine

All Metro North HHS staff impacted by isolation / quarantine must be registered with the Metro North HHS Emergency Operations Centre via EOC-MetroNorth@health.qld.gov.au.

6.5.4.2 Staff wellbeing strategy

The Metro North Wellbeing Strategy – COVID-19 covers the emotional, financial, physical and social domains of wellbeing. Patient Services follow MN guidelines.

Metro North’s values of compassion, integrity, respect, teamwork and high performance form the foundation of decisions and actions relating to the wellbeing strategy during COVID-19. The position of Chief Wellbeing Officer is accountable for the strategy.

The aims of the strategy are to ensure staff feel supported and have their wellbeing considered, link to existing resources and provide access to new initiatives tailored to COVID-19.

New initiatives include:

• COVID-19 HR hotline • Peer responder program to provide psychological first aid • RUOK’ERS to provide a collegiate support network • COVID Staff Psychology Support – a tailored onsite counselling service for any employee who has increased risk to their mental wellbeing resulting from working directly with COVID-19 patients

Profession focussed support and initiatives are outlined in the Metro North Wellbeing Strategy as well as professional association support included below:

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• Medical Professional Association Support • Nursing Professional Association Support • Allied Health Professional Association Support

Metro North’s Employee Assistance Service (EAS) provider Benestar is offering expanded support as part of the Staff Wellbeing Strategy.

6.5.4.3 Industrial relations Engagement with the various unions will occur throughout the pandemic.

6.5.4.4 Reallocation

Patient Services follow MN guidance. No separate or special requirements for Patient Services. Workforce management coordinated by existing roles across the Directorate. Metro North HHS may be required to reallocate staff in response to the COVID-19 activities. These reasons could include (but are not limited to) are:

• vulnerable staff that are unable to be reallocated within their own teams, • service changes including reduction or closure of services, • reduction in workload due to business focus changes.

A range of resources are published on the Metro North extranet page, that support the process of staff reallocation ensuring a streamlined approach. Resources include:

• Orientation Handbook has been developed to support reallocated (deployed) staff. All reallocated (deployed) staff are required to complete the Orientation Handbook to comply with Workplace Health and Safety, patient safety and scope of practice requirements. • Checklist to support reallocation of Metro North workforce during COVID-29 pandemic • A Nursing and Midwifery factsheet has been developed to assist nursing and midwifery decision-making in respect to Scope of Practice, Reallocation and Deployment of nurses and midwives during a COVID 19 pandemic response.

A central process will prioritise and manage the reallocation of staff across the HHS. Patient Services coordinate this locally through existing processes, with reporting back to Metro North Executive.

The Directorate Workforce Coordinators (DWC’s) are supported by the Metro North Emergency Operations Centre (EOC) Logistics – Workforce team to assist and support the reallocation process of employees.

6.5.4.5 Workplace health and safety

Patient Services Follow MN guidance. No separate or special requirements for Patient Services. Workplace health and safety precautions are being taken in line with the Chief Health Officers advice. Public Health surveillance, rapid response teams and case investigation will be available. A range of COVID-19 specific health and safety checklists and factsheets have been developed on local induction, workplace injuries (for employees and line managers), QSuper, Workcover and related to management of uniform/clothing for staff working with patients suspected or positive for COVID-19.

6.5.4.6 Recruitment and onboarding Patient Services Follow MN guidance. No separate or special requirements for Patient Services. All Staff Orientation for COVID-19 has been described in a factsheet and will be delivered to each new starter as an online module. During the COVID-19 emergency response period any new starter joining Metro North will still need to undertake their mandatory training. These will be assigned to them in the Metro North Learning Management System (LMS) as per the Policy. This will include the new Metro North Orientation module. The information provided on the Mandatory Training page outlines legislative and mandatory training requirements, standards and assessments, including the frequency of training that must be completed to enable a safe working environment for everyone, including our patients and consumers.

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6.5.4.7 Fatigue Management Patient Services Follow MN guidance. No separate or special requirements for Patient Services. Management of Fatigue across MNHHS occurs in accordance with the MNHHS Fatigue Risk Management Procedure and the Department of Health Fatigue Risk Management Policy I1 (QH-POL-171). A summary document has been developed which outlines the general management of fatigue. Specific guidelines for relating to fatigue risk management for Medical and Nursing and Midwifery professional streams has also been developed.

6.5.5 Financial management Cost identification and capture processes are to be captured in incident response cost centres in Directorates (one for screening and indirect costs and one for direct costs of patient care). Patient Services continues tracking cost of changes for workforce responses to local facility plans. Costs will be collected by Patient Services (including supporting documentation) and claimed by Metro North HHS via DoH. Funding (to offset actual expense) will be accrued at end of month by Health Funding and Data Insights team. This will be allocated to directorate level against incident cost centres. Adjustments have been made to monthly performance reports to identify incident related costs. The financial delegation matrix in S/4 has been updated to ensure that online orders against emergency event cost centres will workflow to appropriate delegates. .

6.6 Control Patient Services follows MN guidance. No separate or special requirements for Patient Services. The Control Phase will be characterised by a vaccine being widely available and the pandemic beginning to be brought under control demonstrated through decreasing pandemic activity, whilst there is uncertainty if additional waves will occur. The focus during this phase is to:

• evaluate the response – what did we stop, what did we start, what did we do differently (clinical and non-clinical and corporate activities) • determine recovery strategies – what do we continue, what do we stop and when, what do we restart and when, what needs to be “caught up” • prepare for a possible second wave • undertake a range of monitoring and compliance activities associated with relaxations of restrictions.

Upon reaching control phase, Metro North HHS will evaluate the effectiveness of the innovative models that have been developed to manage the pandemic to determine what models should be incorporated into the new normal business environment. Metro North HHS will adopt a phased approach for resuming business activities and determining strategies to assist with “catching up” where necessary.

6.7 Recover Patient Services follows MN guidance. No separate or special requirements for Patient Services. The Recovery Phase is characterised by the pandemic being under control in Australia however further waves may occur if the virus drifts and/or is reimported into Australia. During this phase there is ongoing evaluation of the response, revision of plans and activation of recovery strategies. The Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) outlines activities associated with this phase including:

• support and maintain quality care

• cease activities that are no longer needed, and transition activities to normal business or interim arrangements

• monitor for a second wave of the outbreak

• monitor for the development of resistance to any pharmaceutical measures

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• communicate to support the return from emergency response to normal business services

• evaluate systems and responses and revise plans and procedures. Metro North will work with other government agencies to consider whether the community require additional services to enable full psychological, social, economic, environmental and physical recovery from the effects of the COVID-19 outbreak. At-risk groups may need additional support. Analysis of available data to evaluate the epidemiological, clinical and virological characteristics of the pandemic will be undertaken and ongoing surveillance measures will be considered and incorporated. Newly developed policies and procedures will be reviewed to determine their ongoing applicability and be updated accordingly.

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Appendix 1: Patient Services COVID-19 Committee list Meeting Contact MN COVID-19 IMT MN EOC MN PPE Usage update (last 24 hours) CFCO Patient Services Weekly Covid managers meeting Director Patient Services Weekly Patient Services service line meetings Relevant manager (PS, PSS, PFS) Daily RBWH Covid-19 briefing EOC TPCH Daily TPCH Covid-19 briefing EOC TPCH