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Table 2 List of decisions, reasons, and decision level

From: SARS and hospital priority setting: a qualitative case study and evaluation

Decisions: Staff and Patients

Reasons

Decision Level

Determine which staff to deploy to help with screening at the doors

Operational need; Screening capability; Infection control; Medical need

Hospital Command

Determine urgent patients and care for those first

Medical need

Individual Clinicians

The hospital as a whole determined few hospital workers unessential

Operational need; Screening capability; Infection Control

Hospital Command

Redeploy staff from screening back to clinical areas

Medical need; Duty to care; Operational need

Hospital Command

Hire screeners

Medical need; Operational need; Infection control

Hospital Command

Remove pregnant staff from the clinical environment

Staff safety

Corporate Command; Hospital Command

Decant staff and inpatients (25) from 8th floor general medicine to make room for SARS unit and potential SARS patients

Operational need; Medical need

Hospital Command; Department Managers/Chiefs

Separate staff entrance from visitor and patient entrance

Operational need; Infection control

Corporate Command; Hospital Command

Send staff home

Infection control

Department Managers/Chiefs

Decisions: Beds

Reasons

Level Made At

Accept SARS patient transfers from other hospitals

Duty to care

Corporate Command; Individual Clinicians

Each GTA and Simcoe County hospital to establish a SARS specific isolation unit.

Infection control

MOHLTC

Hospitals greater than 500 beds will be expected to provide a 30 bed unit each. (Mar 27)

  

Create SARS unit physical space on 8B with negative pressure capabilities

Directive; Infection control; Medical need; Operational need; Duty to care

Hospital Command; Department Managers/Chiefs; Individual Clinicians

Decisions: Clinical Activity

Reasons

Decision Level

Maintain emergency based activity during initial days of outbreak

Duty to care; Medical need

Corporate Command; Hospital Command

Ramp up clinical activity

Duty to care; Medical need

Corporate Command

Allocate OR time by division

Medical need; Surgeon activity

Department Managers/Chiefs

Determine which patient needed urgent OR care this could be listed second

Medical need

Individual Clinicians

SARS II – the decision not to cancel surgery again

Medical need; Duty to care

Corporate Command

Treat some 'elective cases' in the OR as being urgent

Medical need; Surgeon activity; Duty to care; Squeaky wheel

Individual Clinicians; Department Managers/Chiefs

Determine what/who is emergent and urgent in terms of clinical volumes in family medicine

Screening capability; Medical need; Squeaky wheel

Department Managers/Chiefs; Individual Clinicians

Family Medicine did not go out into the community to provide care in the initial stages of SARS (care to detox centres, shelters)

Infection control; Screening capability

Corporate Command; Department Managers/Chiefs

Decisions: Visitors

Reasons

Decision Level

No Visitor Policy except for compassionate grounds (such as palliative care, critically ill children or visiting a patient whose death may be imminent)

Infection control

MOHLTC

Restrict visitors for certain hours (5–9 pm)

Screening capability

Hospital Command

Lift visiting restrictions on case-by-case basis

Compassion; Squeaky wheel; Medical need

Department Managers/Chiefs

Hospitals must restrict access to each hospital site. Ideally, access should be restricted to one staff and one public entrance for each building

Infection control

MOHLTC