ensuring healthcare safety throughout the covid-19 pandemic · patient safety: a systematic review....

41
Unclassified//For Public Use TRACIE HEALTHCARE EMERGENCY PREPAREDNESS INFORMATION GATEWAY ASPR ASSISTANT SECRETARY ~- OR PREPAREDNESS AND RESPONSE Ensuring Healthcare Safety Throughout the COVID-19 Pandemic June 2, 2020 Access the recorded webinar here: https://register.gotowebinar.com/ recording/1770593459557872143 Access speaker bios here: https://files.asprtracie.hhs.gov/documents/ aspr-tracie-ensuring-healthcare-safety-throughout-the-covid-19- pandemic-webinar-speaker-bios.pdf Access Q & A here: https://files.asprtracie.hhs.gov/documents/aspr-tracie- ta-covid-19-healthcare-safety-qa.pdf Unclassified//For Public Use

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UnclassifiedFor Public Use

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collection of audience-tailored materials bull Subject-specific SME-reviewed ldquoTopic Collectionsrdquo bull Unpublished and SME peer-reviewed materials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

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

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