CHQ COVID-19 Readiness and Response Plan August 2020

Table of Contents

Introduction ....................................................................................................................................................................................... 1

Purpose ................................................................................................................................................................................... 1

Scope and key objectives ......................................................................................................................................................... 1

Roles and responsibilities .................................................................................................................................................................. 2

Authority and activation ............................................................................................................................................................ 2

Overview of statewide tier 0-5 approach ............................................................................................................................................ 2

Working together to support statewide access to paediatric care ........................................................................................................ 3

Our readiness and response approach .............................................................................................................................................. 4

Response through our established services .............................................................................................................................. 5

Surge capacity response during COVID-19 pandemic ............................................................................................................... 6

Statewide considerations .......................................................................................................................................................... 7

Review and evaluation ...................................................................................................................................................................... 8

Key supporting documents ................................................................................................................................................................ 8

Appendix 1 Tier 0 Prevent local transmission and prepare ......................................................................................................... 10

Appendix 2 Tier 1 Limited community transmission .................................................................................................................... 12

Appendix 3 Tier 2 Moderate community transmission ................................................................................................................. 14

Appendix 4 Tier 3-5 Significant community transmission ............................................................................................................ 15

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Introduction

Purpose

The following plan provides a strategic overview of Children’s Health Queensland’s (CHQ) evolving planning and response to the global

pandemic, novel coronavirus (COVID-19). The plan articulates the approach and tactics which will be triggered to support Metro-Brisbane and

statewide access to paediatric healthcare services.

The current context is complex and ever-changing. Given this, the CHQ COVID-19 Readiness and Response Plan will remain a live document

which will be reviewed and updated in response to new information and changes within the environment.

Scope and key objectives

The CHQ COVID-19 Readiness and Response Plan has been established in a complex planning environment and inter-relates to many

internal and external plans at a local, state-wide and national level (see document list).

Overall, this plan functions as a key decision-making tool for CHQ’s Divisional and Executive Leadership Team (DDELT) and provides

overarching information to support and align localised surge and disruption plans across all CHQ divisions, services and corporate functions.

It has been developed in the context of the Queensland Health Pandemic Influenza Plan, Australian Health Management Plan for Pandemic

Influenza and Australian Health Sector Emergency Response plan for Novel Coronavirus (COVID-19) and should be utilised alongside CHQ’s

Code Brown (External Emergency) disaster management plan.

Key objectives of the CHQ COVID-19 Readiness and Response Plan include:

• Provide overarching visibility of state-wide tiered approach that guides CHQ’s response to increasing demand, associated capacity,

staffing and resourcing challenges whilst maintaining safe infection control measures before, during and after the COVID-19 event.

• Articulate the process and likely thresholds for escalation and de-escalation between tiers 0-5.

• Outline CHQ’s COVID-19 pandemic plan in relation to both the state and national respiratory pandemic management plans.

• Provide an effective health response framework to contain and control the disease as well as reduce morbidity and mortality associated

with COVID-19.

• Provide alignment to relevant policies, procedures and work instructions that support implementation of a functional organisational

response to COVID-19, including management of large influxes of paediatric patients with respiratory or transmissible viral illness (and

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their families), requiring a surge in health service response which may include the provision of mass vaccination and influenza like

illness (ILI), novel organisms assessment and fever clinics.

Roles and responsibilities

Authority and activation

On 29 January 2020 the Minister for Health and Minister for Ambulance Services made an order declaring a public health emergency relating to

coronavirus disease (COVID-19) under the Public Health Act 2005 (Qld). During a public health emergency, the Chief Health Officer can issue

Public Health Directions to assist in containing, or to responding to, the spread of COVID-19 within the community. On 17 August 2020,

Queensland’s declared public health emergency for COVID-19 was extended to 11.59 pm on Friday 2 October 2020.

Activation of the CHQ COVID-19 Readiness and Response Plan is authorised by the CHQ Health Service Chief Executive (HSCE), Executive

Director Clinical Services (EDCS), the Executive Director Clinical Services, Queensland Children’s Hospital (EDCS-QCH) or their nominated

delegate, under the following conditions:

• Activation of the Queensland Health Pandemic Influenza Plan; or a Declaration of a State of Emergency due to an outbreak that

constitutes a Public Health Emergency in accordance with the Public Health Act 2005 and the Queensland Health Disaster and

Emergency Incident Plan.

• Potential or actual threat of a transmissible virus and/or seasonal influenza or another transmissible respiratory infection with the ability

to overwhelm CHQ service capacity.

When activating the plan, the HSCE, EDCS-QCH, EDCS or delegate will determine the appropriate tier of response activation. If required, the

Health Emergency Operations Centre (HEOC) procedure is enacted.

Once activated, the command and control arrangements will be implemented in accordance with the CHQ Managing organisational disruption

policy. In addition to roles outlined in the HEOC procedure, collaboration with Infectious Disease and Infection Management and Prevention

Service will be required. Other key stakeholders may be called upon to provide expert advice to the HEOC team.

Overview of statewide tier 0-5 approach

CHQ has aligned its COVID-19 planning to the Framework for the tiered Queensland Health response to COVID-19 (tier 0-5). CHQ will respond

based on the planning and preparedness activities in place and will appropriately move between tiers in line with the current external and

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internal demands on services. This process will be governed and supported by business as usual disaster management processes including

the Health Emergency Operations Centre (HEOC).

Overarching and aligned tier response plans can be found in appendices 1-4. All phases of the response are supported by the Infection Control

Guidelines for the Management of Coronavirus and key strategies identified by the Case Management and Infection Prevention and Control

workstream.

Working together to support statewide access to paediatric care

CHQ performs a critical role in maintaining access to paediatric services while supporting state-wide capacity surges. To support children,

young people and their families across the state, CHQ will apply the below core principles to support access to care.

TIER 0 / TIER 1

Prevent local transmission and

prepare/Limited community transmission

TIER 2

Moderate community

transmission

TIER 3 – 5

Significant community

transmission

Recover and

regenerate

CORE PRINCIPLES

• Support safe paediatric care as close to home as possible

• Recognise statewide staff wellbeing and local capacity

• Implement a tiered response to maintain access to essential services and quality of care

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Our readiness and response approach

CHQ applies a workstream governance structure to our COVID-19 readiness and response approach, with our tier response plans, found in

appendices 1-4, aligned to the following workstream functions:

TIER 0/TIER 1

Prevent local transmission and

prepare/Limited community transmission

TIER 2

Moderate community

transmission

TIER 3 – 5

Significant community

transmission

Recover and regenerate

Local capacity to supply paediatric

demand Demand Adult demand accelerating,

impacting paediatric supply

Minimal / nil local capacity for

paediatrics

Local capacity to supply

paediatric demand

Access available to local services Access Retrieval capacity may be

restricted

Access to QCH may also be

restricted

Access available to local

services

Local workforce operational Workforce Local workforce may be

redeployed to adult services

Leverage statewide paediatric

capability

Local workforce operational

System conditions:

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Response through our established services

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Surge capacity response during COVID-19 pandemic Refer to local Disruption and Disaster Management Plans (DisMaPs) for detailed local surge capacity

Area Tier 1 Tier 2 Tier 3

IPU Surge Bed capacity

205 247 306

ED Capacity Emergency presentations increase by >10% from BAU activity (~230-280 presentations/day)

Emergency presentations increase by >20% from BAU activity (~280-340 presentations/day)

Emergency presentations increase to >340

presentations/day.

PICU Bed

Capacity

23 36 46

CYMHS Bed Capacity

8BC - 6 8BA - 8

Combined capacity 20 Discharge inpatients as able and safe to do so into outpatient care/telehealth services.

Seek support from community mental health services.

Family Testing Clinics and Screening Points

Family Testing Clinic Capacity

CCHR Family Testing Clinic 6 testing bays, testing ability dependant

on demand and staff availability

Total staff required Clinical staff required: 2-6 dependant on demand

Administration staff required: 1.5-6 dependant on demand

Marshall

1 when required during peak demand

Screening

Points

QCH Screening Points:

1 x Raymond St entrance 1 x Stanley Street entrance

1 x QCH car park entrance

Total staff required Clinical staff required:

7-9 dependant on demand

Security staff:

1 (3) at each screening point

Pressure and isolation room Capacity

Total negative pressure rooms

15 Total number of isolation rooms

10

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Statewide considerations

Inter-hospital transfers

Inter-hospital transfers will be coordinated by Children’s Advice and Transport Coordination Hub (CATCH) for non-critical patients.

Critically ill retrievals and transfers are performed by Children’s Hospital Queensland Retrieval Services (CHQRS), coordinated by CHQRS

Paediatric Medical Coordinator (PMC) via Retrieval Services Queensland (RSQ). Staff will need to remove PPE and decontaminate retrieval

equipment in the designated area at the receiving facility. Security staff will have access to PPE to escort CHQRS teams when required.

Refer to CHQRS and CATCH local disruption and disaster management plans.

Inter-state and international transfers

Where inter-state border closures and restrictions are in place and if an infant or child requires to be treated in a CHQ facility or requires

repatriation home post treatment, local teams will:

• Assist families to gain the correct documentation to clear border checkpoints and/or exemptions when required

• Ensure the Children’s Advice and Transportation Coordination Hub (CATCH) is aware and involved in communication with appropriate

state-wide agencies

• Ensure Children’s Hospital Queensland Retrieval Services (CHQRS) are aware of any state-wide directions

• Contact District Disaster Management Unit (DDMU) for assistance to ensure state-wide considerations are included.

For international travellers, government mandated hotel quarantine may be required. This will be dependent upon the current legislation and

border directions. Cases involving international transfers may require the support of the District Disaster Management Group (DDMG), border

force and/or the National Incident room (NIR) to ensure visa and Australian exemptions are adequate as per the current travel restrictions and

requirements.

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Review and evaluation

A review of a COVID-19 readiness and response will be undertaken, with support and facilitation provided by the Infection Management and

Prevention Service and Infectious Diseases and the Disruption and Disaster Management Unit. A debrief or review process should attempt to

identify the effectiveness of systems, preparedness, operational responses and identify areas which may require improvement.

Where the COVID-19 readiness and response plan has been activated, and there has been changes in infection control management

strategies or an exercise has been conducted, the plan will require review. This analysis may involve input from multiple stakeholder agencies.

The focus is on improvements, systems, processes and human factors not individuals. The review should consider the effectiveness of:

- Prevention: any applicable preventative strategies, alterations to infection control and prevention strategies

- Preparedness: education, training, procedure plans and arrangements.

- Response: notification, communication, command, control, collaboration, specific response strategies.

- Recovery: Recovery arrangements and implemented strategies

Key supporting documents

CHQ-POL-62427 Managing Organisational Disruption

CHQ-PROC-62431 – Disruption and Disaster Management – Assurance

CHQ-PROC-62433 Disruption and Disaster Management – Prevention and Preparedness

CHQ-PROC-62434 Disruption and Disaster Management – Response and Recovery

CHQ-PROC-62430 Health Emergency Operations Centre (HEOC)

CHQ-PROC-62420 Code Brown External Emergency / Disaster

CHQ-PROC-62435 Emergency Management

CHQ-PROC-00107 Patient Flow Escalation Response

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CHQ-PROC - 63110 Standard and Transmission and protective based precautions

CHQ-PROC-63330 Infection control guidelines for management during respiratory pandemic

CHQ-PROC-63210 Admission Screening and Safe Patient Placement

CHQ-PROC- 63505 Hand Hygiene and Bare Below the Elbow

CHQ-PROC-63317 Donning and Doffing of Personal Protective Equipment (PPE)

CHQ-WI-80135 Intubation and ventilatory care of patients with respiratory infections that are (or may) be spread by aerosols.

CHQ-PROC-63002 Infection Control Guidelines for the Management of Coronavirus (MERS, SARS, SARS-CoV-2 or Novel Coronavirus)

CHQ-PROC-63005 Transport of suspected and confirmed (MERS, SARS, SARS-CoV-2 or Novel Coronavirus)

CHQ-GDL—63327 The management of children with COVID-19

CHQ-WI-80135 Paediatric Respiratory Care during the COVID-19 Pandemic for all acute and chronic inpatients with respiratory disease

CHQ-WHSPROC-09 Work Health, Safety and Wellbeing – Work from Home

All COVID-19 related governance documentation, including Divisional and work area specific policies, procedures and work instructions, are

available on the COVID-19 Staff Portal and Governance eCatalogue.

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Appendix 1 Tier 0 Prevent local transmission and prepare

Triggers • The Pandemic is well controlled in Australia, further waves may occur if the virus drifts and/or is re-imported into Australia. Currently there is no community

transmission.

• Reduced presentations of suspected of confirmed pandemic disease, although capacity must me adjusted based on demand.

• Sick Leave continues to impact CHQ due to testing and quarantine requirements.

• Return to Normal functioning whilst following CHO directions. i.e. social distancing.

Tier 0: No community transmission

Leadership and Governance

• Enact workstream

governance structure and PMO

• Weekly Tier Zero update

• Daily tiered huddles

• Daily reporting to SHECC

• Screen all patients, families

and visitors at CHQ facilities and services; with clinical

and security support

Workforce

• All staff to maintain Infection Control Guidelines and

COVID-19 Guidelines

• PPE education and skills

retention workshops as

needed

• Promote seasonal Flu

vaccine programs

• Encourage Work from Home

arrangements where

suitable.

• Enhance existing Staff

Wellbeing Programs

• Engage key stakeholders and external partners to

ensure maintenance BAU

services

• Volunteers engage in low risk

activities

• Visitation and Access during

COVID-19 Pandemic Period

• Monitor feedback

• Utilise MyQCH app for

updates

• Ensure consumer

engagement is sought

Patient and Family

Engagement

Essential Health Services

Emergency Department

• Maintain as BAU (~175+)

• Utilise Orange Zone for

patient presenting with COVID-19/ILI symptoms

• Work with testing clinic to balance demand

Essential Support Services

Testing Clinic

• Clinic establishment: Children’s Centre Health

Research Centre Raymond Terrace

• Adjust capacity based on demand

Outpatients

• Rescheduling or utilising virtual care models where

safe to do so

Inpatients

• Maintain as BAU: 205 Beds + non-booked admissions

• Continue booked surgical admissions

• Follow escalation response procedure to increase capacity.

• Minimise patient movements across QCH

• Use of portable imaging, bed

side Meal Delivery for COVID 19

• Continue HITH

PICU

• Maintain as BAU:

23 Beds + emergency

admissions via CHQ

Retrieval Service and ED

• Continue booked surgical

admissions

• Follow escalation response

procedure to increase

capacity

Management of Supplies

• Daily PPE dashboard

stocktake

• PPE ordering to PAR

• Maintain dashboards for stock usage in dietetics,

pharmaceuticals, CRS, BTS, pathology and contractor

services.

• Follow established Cleaning

Matrix

• Maintain BAU PAR level

Linen Supply Guide

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Statewide Considerations

• Support safe paediatric care

as close to home as possible

• Recognise statewide staff

wellbeing and local capacity

• Implement a tiered response to maintain access to essential services and quality

of care

• BAU utilisation of CATCH

and CHQRS services

Communications

• Regular COVID-19 updates

• Weekly COVID-19 EDMS

updates

• Utilise daily tiered huddles to communicate information, provide updates and discuss

concerns.

• Use of online platforms to

continue meetings

• Communication channels:

o COVID-19 Staff and

Family portals

o Digital and physical

signage

o MyQCH app and

o Social media platforms

Essential Health Services

Mental Health

• Maintain as BAU:

14 inpatient beds

• Utilise community mental

health supports

• Utilise virtual platform

• Utilise the Birdies’ Tree

resources Birdies' Tree

Essential Support Services

Community

• Maintain as BAU

• Maintain essential services

within Child Health Services such as immunisation and feeding support clinics via

face-to-face clinics, limit

consultation times

• Utilise virtual platforms

Decision Support and ICT

• Ensure systems remain

functional during and post

the event

• Establish ICT structures throughout dedicated surge

areas

• Ensure Digital Response

Team is engaged.

• Undertake technical infrastructure assessment to

determine possible Digital infrastructure gaps in surge

areas

• Identify service gaps and

technical risk areas and ensure rectification work is

undertaken where possible

• Ensure Digital Training is

engaged and providing clinical and non-clinical

training to identified staff

• Liaise with business areas to

determine reporting and data

requirements for next stages

• Check current stocks of necessary Digital equipment

and commence ordering of

depleted stock

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Appendix 2 Tier 1 Limited community transmission

Triggers • Paediatric patients and their families present to CHQ Emergency Department and Family Testing clinic suspected or confirmed ILI/COVID-19 symptoms or

high risk travel.

• Demand for paediatric care across CHQ is increasing, CHQ will be able to increase capacity and remain in a business as usual model during this phase.

• Staff sick leave increases above annual averages.

• Community services ability to provide care in BAU geographical areas may be affected due to the demand from other Hospital and Health Services to utilise

space.

• Increased demand for the use of PPE due to state-wide or national directions.

Tier 1: (Mild) Locally acquired cases

Leadership and Governance

Additional to Tier 0:

• Establish IMT

• Activate lead forward HEOC

• Activate COVID-19

Readiness and Response Plan

• Activate local and service

level DisMaPs or services plans

• Implement planning strategies to increase capacity and secure

additional resources

Workforce

Additional to Tier 0:

• Apply CHO directions within

hospital setting

• Enact staff management

plans including sick leave

• Activate absence

management process

• Social distancing

enforcement in tea rooms

and shared spaces

• Limit volunteer service to those impacting service

delivery (wayfinding and

patient / carer orientation)

• Flexible suspension of non-essential meetings and

education programs

• Continue essential education

• Security – review model and

increase support where

required

Essential Health Services Essential Support Services

Emergency Department

Additional to Tier 0:

• Emergency presentations

increase by >10% from BAU activity (~230-280

presentations/day)

• Activate ED DisMaP

Testing Clinic

Additional to Tier 0:

• Increase and /or reallocate

staff to increase capacity

Outpatients

Additional to Tier 0:

• With the support of Communication and

Engagement team service leads/NUMS to support families requiring essential

care at CHQ services

Additional to Tier 0:

• Update information based on CHO Public directions, i.e. visitation guidelines and

PPE requirements

Patient and Family

Engagement

PICU

Additional to Tier 0:

• Activate PICU DisMaP

Inpatients

Additional to Tier 0:

• Activate local DisMaPs for

inpatient units and Operative

and Recovery Services

• Increase HITH capacity

• (~20)

Management of Supplies

Additional to Tier 0:

• Increase PPE stock levels as demand increases, update

dashboard

Decision Support and ICT

Additional to Tier 0:

• Activation of Digital

Response Team

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Statewide Considerations

Additional to Tier 0:

• Continue to provide essential community, outpatient and

inpatient services

• Support statewide capacity building by leveraging

existing models: Clinical Advice and Transport

Coordination (CATCH), Virtual PICU and Ward

Rounding, ECHO

• PICU state-wide virtual ward

and close observation

telehealth model

• Paediatric virtual consultations (inpatient and

outpatient)

• Alternative outreach models

via telehealth

• Paediatric-specific COVID-19

information

• Activate CHQRS and CATCH DisMaPs for

management of children

needing transportation

Communications

Additional to Tier 0:

• Maintain

• Daily COVID-19 updates

• Daily updates of

communication channels:

o COVID-19 staff and family

portals

o Physical and digital

signage

o MyQCH app

o Social media platforms

Essential Health Services

Mental Health

Additional to Tier 0:

• Activate CYMHS service

Plans/ DisMaP

• Maintain

Community

Additional to Tier 0:

• Activate CYCHS DisMaP

• Maintain activity and critical

referrals to essential services

• Consider the need to combine face to face service

as facility space may be impacted by the demands

from another HHSs

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Appendix 3 Tier 2 Moderate community transmission

Triggers • Escalating demand from COVID 19 and non-COVID19 patients with an impact to business as usual activities throughout CHQ services and facilities.

• Staffing sick leave increases, 10- 25%. Staff absenteeism due to childcare responsibilities may impact on staffing availability

• Sustained demand for access to PPE due to public health directions and increased capacity.

Tier 2: Moderate, locally acquired cluster

Leadership and

Governance

Additional to preceding tiers:

• Activate CODE Brown Stand Up

• Continue CHO directed public health measures, surveillance and update specific pathogen requirements for infection control management and prevention

Additional to preceding tiers:

• Maintain updates

• Consider cessation of non-essential family entertainment services i.e. starlight

• Provide virtual distraction and entertainment platforms

Patient and Family Engagement

Workforce

Additional to preceding tiers:

• Suspend all non-essential meeting and training, move to online platforms

• Cease volunteer

engagement

• Access essential meetings via virtual platforms only

Communications

As per preceding tiers:

• Maintain updates

Essential Support

Services

Outpatients

As per preceding tiers:

Maintain

Management of Supplies

As per preceding tiers:

Maintain

Decision Support and ICT

As per preceding tiers:

Activation of Digital

Response Team

Essential Health Services

Emergency Department

Additional to preceding tiers:

• Emergency presentations increase by >20% from BAU activity (~280-340 presentations/day)

Inpatients

Additional to preceding tiers:

• Enact expanded clinical capacity – admit to physical capacity 247 beds

• Increase HITH capacity (~30)

Mental Health

Additional to preceding tiers:

• Enact expanded clinical capacity – admit to physical capacity inpatient capacity 20 beds

Testing Clinic

As per preceding tiers:

Maintain

PICU

Additional to preceding tiers:

• Enact expanded clinical capacity – admit to physical capacity 36 beds

Community

As per preceding tiers:

Maintain

Statewide Considerations

Additional to preceding tiers:

• Respond to demand by increasing PICU and ward capacity for increased statewide flows

• Cohort paediatric care at QCH as appropriate and accessible

• Limit/cease back transfers from HHSs as required

• Increase telehealth utilisation for virtual ward rounds and consultation as required

• Expanded Critical Care and Inpatient capacity for enhanced flows to QCH

• Expanded paediatric

HITH catchment

• Expanded local QCH catchment

• Altered back transfer protocol

• Cease adolescent transitions

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Appendix 4 Tier 3-5 Significant community transmission

Triggers • Sustained escalated and increased demand for paediatric care across CHQ facilities and services.

• Adult services are referring patients to CHQ and may seek assistance and support from CHQ to manger an increasing number paed iatric and young adult

patients.

• Staffing sick leave increases, 25-50%.

• An increasing number of community services will be impacted due to the demand from other Hospital and Health Services to utilise CHQ facilities and

space.

• Increased and sustained demand for access to PPE, consumables and equipment due to capacity demands.

• Capacity reached within CHQ inpatient services.

Tier 3: High locally acquired

Leadership and Governance

Additional to preceding tiers:

• Ensure fatigue management

is considered by HEOC

Workforce

Additional to preceding tiers:

• Recall staff from leave as

appropriate.

• Continue working with contracted services to

increase capacity

Essential Health Services Essential Support Services

As per preceding tiers: Maintain.

Patient and Family

Engagement

Emergency Department

Additional to preceding tiers:

• Emergency presentations increase to >340

presentations/day

Testing Clinic

As per preceding tiers: Maintain

Outpatients

Additional to preceding tiers:

• All appointment to rescheduled, cancelled and

moved to virtual platforms

• Emergency activity only Inpatients

Additional to preceding tiers:

• Enact expanded clinical

capacity – admit to physical

capacity 306 beds.

• Increase HITH capacity (~40)

PICU

Additional to preceding tiers:

• Enact expanded clinical

capacity into PACU – admit

to physical capacity 46 beds

Management of Supplies

Additional to preceding tiers:

• Maintain and increase as per

demand requirements

Communications

As per preceding tiers: Maintain

Decision Support and ICT

As per preceding tiers:

Activation of Digital Response

Team

Mental Health

Additional to preceding tiers:

• Seek support from

community based mental health programs and access

virtual platforms

Community

As per preceding tiers: Maintain

Statewide Considerations

Additional to preceding tiers:

• Respond to demand by

further increasing PICU and ward capacity for statewide

flows.

• Expand age limits to provide

critical and essential care to young adults (in alignment

with existing expertise).

• Expanded age range to

include young adults.

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In the instance where hospital and health services are at capacity and have exceeded their phased planning, the District Disaster Coordination Centre (DDCC) with the support of the DDMG will activate a Tier 4 response engaging the private hospital networks; followed by a Tier 5 response. This will include the activation of the Brisbane Convention Centre field hospital.

Tier 4: Crisis Collaborate with the District Disaster Management Group (DDMG), MNHHS and MSHHS to utilise private hospital space. Emergency activity only.

Tier 5: Extreme Collaborate with DDMG, MNHHS and MSHHS to access and establish paediatric space in designated field hospital/s. Emergency activity only.