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) | Â | Â |
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 |