P3.C047: Lessons in Community Hospital Disaster Planning From A Satellite Children’s Hospital

Background: As more and more community hospitals decrease their pediatric emergency and inpatient capacity, a gap in access to pediatric care has emerged. Pediatric tertiary care centers are increasingly expanding into community settings; this expansion poses unique challenges for hospital emergency preparedness (EP) given the need for disaster plans that reflect the satellite’s location, resources, staffing and capabilities, while maintaining integration across the hospital system.
In January 2022, our large tertiary pediatric hospital opened its first community satellite hospital, located in the suburbs 20 miles west. This 81-bed facility includes a 24/7 pediatric emergency department (ED), PICU and NICU, as well as an outpatient specialty care center with associated Urgent Care (UC). We present three years of disaster planning for this satellite location.

Methods: In winter 2021, approximately one year prior to opening, the satellite hospital’s Emergency Preparedness Committee (SEPC) was established. This committee has been co-led by two satellite hospital EP planners and the EP Associate Medical Director who are all are fully integrated with hospital system EP. SEPC meets monthly and has expanded to include representation from ED nursing, nursing leadership, pediatric emergency medicine, PICU and UC physician leadership, security, social work, patient registration, acute care technicians, radiology, respiratory therapy, and blood bank. SEPC is represented on the hospital system EP and mass casualty incident (MCI) committees, allowing for maximal integration.

Results: SEPC has established site-specific protocols, provided regular educational programming, and run interprofessional exercises (see Table 1). Since the satellite hospital’s opening, all exercises conducted- whether primarily run by central or satellite hospital EP teams- have included participants from both campuses, fostering awareness of disaster procedures and collaboration across the hospital system. SEPC has created and iteratively revised its own disaster algorithm (Figure 1) mirroring the central hospital algorithm while providing adjusted acceptable numbers of patients and resource focused multiple patient event (MPE)/MCI definitions. Additionally, SEPC developed a site-specific Family Reunification plan reflecting satellite hospital facility aspects and the potential need for movement of patients and/or family members between hospital campuses. Finally, a SEPC subgroup crafted a site-specific surge plan in response to the tripledemic; one key strategy involves ED staff utilizing adjacent unoccupied UC space to increase ED capacity. Patients may also be moved between campuses within the hospital system depending on capacity. We have incorporated the potential use of UC space into satellite hospital disaster plans and created a disaster job aid for UC physicians.

Conclusion: Disaster planning for community satellite children’s hospitals is increasingly important as pediatric tertiary care systems continue to expand. Planning for community satellites with comparatively fewer resources can prove challenging. Maintaining strong integration with hospital system EP is important and helps ameliorate some of these challenges.