P3.C043: From Crisis Response to Enterprise Operations: Developing a System-wide Playbook for Sustained Patient Surge

Background: In Fall 2022, the nation faced an extreme and early surge in respiratory viral illnesses, leading to a national crisis for children’s hospitals and significant demand for services across the patient care continuum. Creative solutions to increase pediatric capacity and support pediatric care delivery were quickly developed and implemented nationwide. At the Children’s Hospital of Philadelphia (CHOP), we quickly identified ways to improve patient flow, decrease emergency department (ED) and inpatient demand, and support the care of children in community, non-pediatric environments. This required collaboration and synergy across multiple segments of the enterprise inclusive of primary care, urgent care, specialty care, acute inpatient, ED, and affiliate network hospitals. A taskforce was implemented to facilitate this coordinated response.

Following the extreme viral surge event, CHOP performed an after-action review of our response and aimed to develop a “Surge Playbook” through an iterative improvement process that built on prior high volume and capacity management work. The aim was to promote a sustained and systems-level approach to capacity management.

Methods: The Department of Emergency Preparedness led playbook development with input from a multi-disciplinary, system-wide committee. Using clinical and operational data analysis, after-action review, and consensus strategies, the playbook was developed and then iteratively evaluated. The goal of the playbook was to provide Enterprise-level guidance on monitoring these indicators, communication pathways to raise awareness, recommended response measures, and interventions that can be employed to mitigate and respond to capacity constraints. In addition, the playbook was also created to include high-impact, area-specific plans to allow for coordinated local escalation.
To understand the impact of the playbook, a retrospective review of past Incident Management Team (IMT) activations for capacity events was performed and staff use of the playbook was quantified.

Results: Development:
The Surge Playbook went live September 20, 2023, as a plan to be executed through CHOP’s Enterprise Mission Control Center by clinical and operational leaders. Area-specific surge indicators were monitored across the enterprise, allowing for situational awareness and creative leveraging of the system to alleviate strain.(see figures) We continued to review and improve the playbook through interval, iterative evaluation. In this process, we recognized that surge response worked best when fully embedded as a part of normal clinical operations, and therefore the document was modified to the “Enterprise Clinical Operations Playbook”, encouraging routine use and integration into Mission Control operations.

Impact:
The IMT was activated for capacity events 4 times in 2021, 3 times in 2022, and 0 times in 2023 (post-implementation). The playbook was accessed 1176 times since go-live.

Conclusion: The Enterprise Clinical Operations Playbook creates a structure for data-informed identification of system strain, promoting a coordinated approach to capacity management and improved situational awareness and response in the face of sustained surge events.