In dealing with the latest threat of the swine flu, the University of Michigan Hospitals and Health Centers also had to determine how to expand its respiratory isolation rooms. Cadwallender says in the case of over-capacity, plans also call for "cohorting" patients who need to be isolated. In addition to determining where to place those patients, UMHHC had to ensure that it could adequately staff up and provide them with specialty care providers. "Once again it becomes a chess game," says Cadwallender. "We spent the last couple of weeks meeting quite frequently to talk about very specific ideas about what we would do if it came to that and fortunately in the meantime things have eased up."
How many supplies do you keep on hand and when do you buy them are other questions that come up in planning. UMHHC has been stockpiling certain supplies, something that flies in the face of today's hospital policies of just-in-time delivery. One issue for those with an eye on the budget is that a stockpile is well, just that. It is huge and there is a good chance that it will not be used before it has to be replaced. Organizations like UMHHC also may have to store supplies at another location because of limited on-site storage.
"We thought we had plenty of masks but now we have decided we need more and that concept of stockpiling things bumps up against our finance and procurement folks," says Cadwallender, adding that the system would like to increase its 20,000 masks to 30,000. "There is a real potential that this thing could come back in fall. If the virus mutates it may not be responsive to antivirals like it was this time." In addition to respiratory masks, UMHHC has stockpiled pharmaceuticals and bottled water.
Purchasing in advance ensures supplies will be available when you need them and avoids having to face rationing. Cadwallender says that as the system tried to purchase additional masks for the swine flu it was told by its supplier that a federal emergency had been declared and that the government would dictate where supplies went. "That was quite a revelation," he says.
While each crisis will have its own set of planning requirements, the swine flu has perhaps forced many organizations to provide some finality to their pandemic or mass care plans. At the very least the experience has offered them a more on-target assessment of strengths and weaknesses. In the case of UMHHC, questions around labor and inpatient planning still need to be worked out.