How to Use the Healthcare Surge Standards and Guidelines Materials

1. CALIFORNIA DEPARTMENT OF PUBLIC HEALTHStandards and Guidelines for Healthcare Surge during Emergencies How to Use the Healthcare Surge Standards and Guidelines Materials

2. How to Use the Surge Standards and Guidelines Materials Objectives of the presentation are to: • Provide an overview of the content of the healthcare surge standards and guidelines materials • Describe the components of the healthcare surge standards and guidelines materials • Healthcare Surge Standards and Guidelines Manuals • Operational Tools Manuals • Training Curriculum • Reference Manual • Provide an overview of how to use the healthcare surge standards and guideline materials effectively

3. Components of the Healthcare Surge Standards and Guidelines Materials • Healthcare Surge Standards and Guidelines Manuals are reference manuals identifying existing regulatory requirements and the ability to modify these requirements during an emergency, guidelines for planning for a surge, and procedures to use in implementing a surge plan. There are four manuals: • Foundational Knowledge • Volume I: Hospitals • Volume II: Government-Authorized Alternate Care Sites • Volume III: Payers The Surge Standards and Guidelines materials are designed to assist in the development of healthcare surge response plans. These materials include the following:

4. Components of the Healthcare Surge Standards and Guidelines Materials (continued) • Operational ToolsManual for the Surge Standards and Guidelines Manual. These include forms, checklists and templates to facilitate and guide the implementation of the recommendations and strategies outlined in the respective Standards and Guidelines Manual. • Training Curriculum for each Surge Standards and Guidelines Manual that outlines the intended audience, means of delivery and frequency of training that will enable adherence to the policies in the manual and overall readiness of the healthcare delivery system. • Reference Manual contains additional material that may be helpful to organizations as they plan their response to a healthcare surge. The reference manual includes content such as an overview of federal and State regulations and compliance issues, detailed information regarding the Hospital Incident Command System roles and responsibilities, and additional information regarding funding sources that were used during previous states of emergency.

5. Healthcare Surge Standards and Guidelines Manuals • The Healthcare Surge Standards and Guidelines Manuals contain recommendations and options for consideration during healthcare surge planning. They also contain a review of existing regulatory requirements and the ways these requirements might be modified or flexed during an emergency. These manuals are designed to assist emergency planners in the development of healthcare surge response plans that meet their organizations’ needs. • These manuals do not contain mandates and the applicability of an individual guideline and recommendation should be evaluated for implementation based upon the specific needs of the emergency.

6. Healthcare Surge Standards and Guidelines Manuals (continued) • With the exception of Foundational Knowledge, each manual was written for a specific audience. • There are four Healthcare Surge Standards and Guidelines Manuals: • Foundational Knowledge. This manual defines healthcare surge, describes the existing emergency response system in California and how healthcare providers participate in this system. It also discusses transitioning patient care from individually-focused to population-based care in a severe surge. This manual is prerequisite to volumes I -III, operational tools, reference manual and training curriculum.

7. Healthcare Surge Standards and Guidelines Manuals (continued) • Volume I: Hospitals. Primarily developed for use by hospitals, but also beneficial for use by other providers and health plans, this manual contains information on general emergency response planning and related integration activities for hospitals. This manual also includes guidance for hospitals related to increasing capacity and expanding existing workforce during a surge, augmenting both clinical and non-clinical staff to address specific healthcare demands, addressing challenges related to patient privacy and other relevant operational and staffing issues during surge conditions. This manual addresses the assets under a hospital's control that can be used to expand capacity and respond to a healthcare surge.

8. Healthcare Surge Standards and Guidelines Manuals (continued) • Volume II: Government-Authorized Alternate Care Sites. This manual contains planning information related to the establishment of government-authorized Alternate Care Sites that may be used for healthcare delivery during a healthcare surge. It includes specific guidance and general planning considerations for coordinating site locations, developing staffing models, defining standards of care and developing administrative protocols. Specific guidance on federal and State reimbursement at government-authorized Alternate Care Sites is also provided.

9. Healthcare Surge Standards and Guidelines Manuals (continued) • Volume III: Payers. This manual outlines specific sets of recommendations for commercial health plans to consider when working with providers, employers and others during the surge planning process. Recommended approaches to changes in contract provisions which focus on simplifying administrative and reimbursement requirements are included. This volume also contains specific information on the impact that a healthcare surge may have on a health plan's administrative and financial relationship with Medicare Advantage, Medi-Cal Managed Care and Workers' Compensation.

10. Operational Tools Manuals • The Operational Tools Manuals were developed to assist in the implementation of the recommendations and strategies in the Foundational Knowledge, Hospitals and Government-Authorized Alternate Care Sites Surge Standards and Guidelines Manuals. The Payers Volume of the Surge Standards and Guidelines Manual does not have a corresponding Operational Tools Manual. • The tools are sample templates, checklists, forms and policies for organizations to use in implementing the Surge Standards and Guidelines. The tools can be modified and applied to meet each organization's specific needs. For some tools, an organization may already have a similar policy or methodology, and the tool will not be necessary. In other cases, the tool may not be applicable to the size or location of the organization.

11. Operational Tools Manuals (continued) • Each tool is included in a Surge Standards and Guidelines Manual, which provides context for the tool, and in that manual’s respective Operational Tools Manual, which allows for direct access to each tool. • In the Surge Standards and Guidelines Manuals, each tool is preceded by an introductory sentence, highlighted in red, that provides the name of the tool. • Users should first become familiar with the tools in the context of the Surge Standards and Guidelines Manual. Once familiar with the tools, users can access them directly from the Operational Tools Manual.

12. Operational Tools Manuals (continued) • The tools in the Operational Tools Manuals are organized alphabetically by tool name by the following major sections: • Workforce/Staff • Supplies, Pharmaceuticals and Equipment • Operations/Structure • Sources of Funds • Each tool within the Operational Tools Manual includes a cover page which contains: • The tool name • A brief description of the tool • Instructions for using the tool

13. Operational Tools Manuals (continued) • The tools from the Hospitals Volume can be found in the Hospital Operational Tools Manual. The tools from the Government-Authorized Alternate Care Sites Volume can be found in the Government-Authorized Alternate Care Site Operational Tools Manual. The tools for Foundational Knowledge can be found at the end of Foundational Knowledge.

14. Training Curriculum • The training curriculum is intended to serve as an overview of the content in the Surge Standards and Guidelines Manual. Each manual has its own training curriculum. • The training curriculum is designed to be used as tool for developing training programs on surge plans. Emergency planners should use this training course as a starting point and customize it to include organization specific surge planning objectives.

15. Training Curriculum (continued) • The training curriculum is made up of the following two components: • Training Powerpoint: A presentation that provide an overview of the content in each of the sections in the Surge Standards and Guidelines Manual. The slides are labeled with the corresponding section title and number of the manual to facilitate cross-referencing between materials. • Training Guide: A document that provide additional information, context and reference information for the content on the Powerpoint slides. Each slide from the Training Powerpoint is included in the Training Guide, along with additional information on the content of that slide that organizations may find helpful in developing training materials.

16. Training Curriculum (continued) The Training Guide provides references to assist in the development of training programs for surge plans. They include:

17. Reference Manual • The reference manual contains additional material that that may be helpful to users as they plan their response to a healthcare surge. • The reference manual includes a collection of material for a range of audiences. • Users should review the sections in the reference manual that are most applicable to their needs.

18. Reference Manual (continued) • Content in the reference manual includes: • A glossary of terms and acronyms used throughout the volumes • An overview of federal and State regulations and compliance issues, including statutes, laws, regulations and standards and their corresponding legal interpretations and potential implications for use during a healthcare surge • Detailed information regarding the Hospital Incident Command System roles and responsibilities • information regarding funding sources that may be available during a declared healthcare surge is included as well as those funding sources that were used during previous states of emergency • The California Healing Arts Boards professional scope of practice guidelines • Fatality management resources • Current patient rights resource guide

19. Using the Healthcare Surge Standards and Guidelines Materials • The Surge Standards and Guidelines materials are designed to be used in collaboration with each other. The manuals and training curriculum are referenced throughout the materials. • The Foundational Knowledge manual sets the stage for all the subsequent materials and provides foundational concepts regarding healthcare surge. It should be read by every audience member. • Each manual defines the concept of healthcare surge planning as related to a particular audience (i.e. hospitals, payers, local health departments) and provides additional resources to guide organizations during planning.