Gallagher Risk Watch – March 2021

• Managing the Environment of Care Webinar
• Surge Planning: Risks of Not Preparing
• Virtual Healthcare: The Alternate Way is Here to Stay

Managing the Environment of Care: Emergency Preparedness, Life Safety and Utilities On Demand Webinar

This educational webinar will focus on management principles and guidance for Administrators, Risk Managers, Safety Officers, evidence of coverage (EOC) Program Leaders in effective leadership techniques for performance based EOC Programs.

As the COVID-19 pandemic continues, hospitals struggle to maintain responsive EOC programs and committees tasked with maintaining existing programs while at the same time developing responses to the ever growing challenges facing an acute care organization. This webinar will be sensitive to the challenges of limited resources and fatigued healthcare staff while at the same time offering suggestions for program enhancement and the effective utilization of staff.

This presentations learning objectives will include:

• Enable attendees to assess their own EOC program and committees
• Attendees will learn program enhancement tools for streamlining life safety program functions and goals
• Attendees will learn new emergency preparedness processes and drill techniques aimed at areas in need of organizational improvement
• Attendees will learn "survey prep" techniques for use in this new era of virtual surveys

The goal for this webinar will be to offer viewers guidance for program improvement and techniques for supporting other EOC team members.

Register Now

Surge Planning: Risks of Not Preparing

Author: Gallagher National Risk Control

The events of the past year have taught us all lessons on the need to plan for emergencies and this is of paramount importance in the Healthcare field. Widespread disasters affect our community and place a strain on health care system resources and adequate preparation can help to plan for and minimize any disruptions in the system and minimize the risks associated with the surge.

According to The Medical Surge Capacity and Capability (MSCC) Handbook, surge planning is the ability to provide adequate medical evaluation and care during events that exceed the limits of the normal medical infrastructure of an affected community. Surge capacity is the ratio of patients to medical beds, staff and consumable resources. This follows the definition of a disaster which states that the needs put on the system outstrips the capacity of the system itself. Surge capacity is the ability to house and treat patients above the standard volume.

Therefore, in order to provide adequate resources during a capacity surge event, whether it's sudden or long term, the following must be considered.

Shifting demand for medical services: This can be done in many ways including by deferring services until the surge dissipates or ends and asking the public to consider urgent care and other facilities instead of visiting the ER. Messaging must be consistent when informing the public on these points. Undoubtedly, this will result in some patient complaints and the potential risks for these complaints can manifest in lawsuits. In addition to other techniques, this risk can be mitigated through clear, open and honest communication with the patients.

Providing alternatives for patient care & patient care facilities: Patients awaiting discharge for other types of care, can be transferred to another facility that can house the patients. Minimizing the disruption to the patient and their family must be considered in this process. Video, telephonic and web based alternatives can help to increase capacity and efficiency as well. All of these alternatives must be carefully considered to help ensure that mistakes are not made in providing alternative care that may be substandard as compared to need. Consider pre-planning with potential alternative care facilities.

Minimizing resource consumption and decreasing demand: This can be done by decreasing the number of patients who are currently in the system. Control of valuable resources is critical in any emergency situation and even more so during a surge event. Careful planning of where to place patients in relation to their illness and where to place resources so they can dispensed accurately and efficiently must take place. Without proper resource deployment, delays in care and treatment are more likely to occur and mistakes are more likely to be made. Care plans and proper documentation are critical risk controls.

Increasing bed capacity: Planning meetings must be held to determine where extra capacity can be created. Amongst the many considerations are the basic infrastructure of the facility including, electrical, water, air, gas and other utility needs. Demand on these resources will tax the systems in place so their capacity must be evaluated long before an actual surge occurs. Moving lower risk patients into areas that are not regularly used for care provides more room for the higher risk patients that need intensive care. Any place that has the room and enough privacy can be converted. Careful planning with local fire and safety officials must be considered in these actions to ensure the facility remains safe.

Further considerations before and during surge events

• Emergency department layout: It will likely become necessary during an event with easily transmissible diseases, especially respiratory events, to ensure your ED is configured correctly and separated into clean and dirty sides. This must include considerations for effective ventilation as well as separation of clean and contaminated equipment and supplies. Staffing considerations for each of these areas has to be considered to ensure they remain separated as much as possible.
• Emergency staffing: When surge events occur, especially if they are prolonged events, it is likely you will need to draw on areas beyond existing staff to meet the demand. Plans should include: temporary and visiting healthcare professional agencies, retired and recently departed staff and the use of volunteers where needed. 
• Conducting drills and tabletop exercises: Therefore, in order to provide adequate resources during a capacity surge event, whether it's sudden or long term, the following must be considered.
• Plan checklists: There are a variety of tools and techniques including checklists that are readily available to help you evaluate your surge plan.
• Having adequate wellness and mental health professionals to assist staff: Stress is clearly a part of everyday life, and can and likely will dramatically increase during surge events. It is best to be prepared for this with a variety of mental health and wellness resources so you will be better able to help staff members in need. ^1,2,3,4,5

Virtual Healthcare: The Alternate Way is Here to Stay

Author: Mary Stoll

Prior to the current COVID-19 pandemic, telemedicine was already recognized as a viable method for delivering care. To adapt to the constraints of COVID-19, physicians began to adopt telemedicine as a way to support the physician-patient relationship and keep their practices in business. To put it in perspective, the AMA reported that by the end of the first quarter of 2020, telemedicine use increased to about one million visits per week.⁶

In late 2020 a survey revealed that, many health care professionals had favorable reviews of telehealth. Consider the numerous benefits such as convenience, reduction of virus transmission, patients' ability to self-monitor, along with savings of time and money. The clinicians found that their patients also had a positive view of virtual medicine.⁷ For example, a physician friend of mine more fully implemented telemedicine in 2020. In summary, he stated, "I just love it. The adoption of video-conferencing has proved to be a preferred modality for me than telephone discussions for my practice". He loves the convenience for many of his compromised patients who would otherwise have delayed their on-site office visits.

Whether you are new to telemedicine or a seasoned adopter, it is important to keep in mind the risks in order to improve patient safety and avoid being sued. The situation at this time with telehealth claims is uncertain. CRICO liability risk data indicates the potential for telehealth allegations of diagnostic errors, mishaps with medical/surgical treatment and medication management.⁸

Remember to have robust systems and policies in place to help reduce risks associated with telehealth services. Consider the following recommendations:

• Clinical Assessment: Use your best judgment with remote diagnosing and evaluate well whether a visit needs to be in-person. Words of wisdom from TheDoctorsCompany, "Patients may present with concerns that cannot safely be evaluated from a distance, even with remote-exam strategies. The physician can request that the patient come in to be seen in person—and can share with the patient the risks of delaying care. In other words, one of the secrets of practicing telemedicine is knowing when not to practice telemedicine."⁹
• Informed consent: Keep clear and accurate documentation and obtain a precise informed consent for telemedicine services.
• Security safeguards: Verify the identity of your patients: Protect ePHI. Is your patient's computer secure?
• Coverage: Confirm coverage necessities with your Medical Professional Liability policy.
• State regulations: Know your state requirements for determining the location of the provision of the practice of telemedicine to make sure you are in compliance.

The hope is for telemedicine to continue to improve rather than replace in-person examinations. As a necessary modality to supplement healthcare during these difficult times, virtual healthcare has been a life saver as long we realize its limits.

Gallagher can help you check with your Medical Professional Liability policy to make sure you are compliant with licensure. For additional resources, visit the Gallagher Digital Health & Telemedicine Resources page.