Baptist Health Arkansas Coronavirus 2019 (COVID-19) CMO Medical Command Center

ICU UNITS

Baptist Health System – Medical staffing management for handling COVID – 19 Surge

Medical Staffing Tiered approach based on needs and capabilities

Acuity level Locations of care Patients profile Staff capabilities Licensees Extenders ( Patient Profile and medical severity ) HIGH Primary : Intubated/ Critical Care Physicians: Hospitalists COVID 19 ICU Critically ill Certification 1.Pulmonary Crit ED Physicians UNITS COVID 19 and/or Care patients in ICU experience. 2.Anesthesiology Cardiologists Added locations: Advanced Advanced Nephrologists PACU’s Cardiac Life Practice Pre-Op Units Support (ACLS)/ Providers: CRNA’s : Trauma Critical Care Acute Care APN’s

All types certification APNs TELEMEDICINE and/or ED experience; MEDIUM Primary : Stable COVID 19 BLS; Related Hospitalists Gastroenterology COVID 19 Med patients Specialty surg UNITS experience Nephrologists Surgery specialties ( Gen Added locations: Non Covid ( Medical surg, Ortho, Outpatient surg patients with specialty ) ENT,Neuro,Urology) centers respiratory APNs : acute medicine / Hospitals: /cardiac illnesses family medicine with All types special permission from competent authorities TELEMEDICINE LOW Primary : Stable non Covid Related/ Active Primary Gastroenterology Med surg UNITS patients unrelated Care providers Surgery specialties Added locations: Surgical patients medical Surgical ( Gen surg, Ortho, ASCs specialty, specialties ENT,Neuro,Urology) Sleep centers Surgery training APNs : Acute medicine / Hospitals: Retired Internal family medicine with All types medicine/ special permission from pulmonary/cardi competent authorities ology / nephrology TELEMEDICINE physicians

Draft The learning and literature are changing frequently, and this document is not intended to replace best possible actions taken by competent authorities. These are general guidelines only. All safety, legal and regulatory requirements need to be considered Baptist Health Arkansas Coronavirus 2019 (COVID-19) CMO Medical Command Center

Baptist Health System – Medical staffing management for handling COVID – 19 Surge

Medical Staffing Tiered approach based on needs and capabilities

CMO-Medical Command Center

High Acuity Units Medium Acuity Units Low Acuity Units ( Patient Profile and ( Patient Profile and ( Patient Profile and medical severity ) medical severity ) medical severity )

Med/Surg Floors ICU Units Med/Surg Floors

1.Pulmonary-Critical care Hospitalists Active Primary care physicians Cardiologists providers 2.Anesthesiologists Nephrologists Surgical specialties 3.ED Physicians

4.Hospitalists ( ICU Extenders) *

*Extenders: Other medical specialties : GI, Hem-Onc,Neuro

Surgery specialties (Gen surg, Ortho, ENT,Neuro,Urology) Other Reserve Medical and Surgical Specialties: Otolaryngology,OB/Gyn,Maternal and Fetal Medicine, Phys Medicine & Rehab,Dermatology,Rheumatology,Infectious Disease, , Neonatology,,Pain Management,,Sleep Medicine,Palliative Care,,Pathology,Sleep Medicine,Wound Care,Dentistry,Oral Surgery,Surgery-Maxillofacial

APNs Notes: 1. All physicians in this list are with privileges and state license 2. High priority group : No additional training needed

3. Medium and Low priority group: chestnet.org and critical care med society resources, ACLS or BLS refresher Draft The learning and literature are changing frequently, and this document is not intended to replace best possible actions taken by competent authorities. These are general guidelines only. All safety, legal and regulatory requirements need to be considered Baptist Health Arkansas Coronavirus 2019 (COVID-19) CMO Medical Command Center

Baptist Health System – COVID 19 ICU Medical Staffing Model Tiered Approach

Ref: Ontario Health plan for an influenza pandemic working group and Society of Critical Care Medicine guidelines 2019

Assumptions, Expectations and Exceptions:

Tier 1 : Team handles non-intubated patients

Tier 2 : Team handles intubated patients

Total patients per pyramid : 24 patients

Clinical Responsibilities:

Attending: All Tier 1 and Tier 2 Physicians assigned as the attending. Primarily responsible for Care, Documentation ( H-P, Progress Notes, Discharges)

Consultations: All consults are either face to face if the resources available or Telehealth Virtual consults facilitated by single rounder.

Extenders: Cardiology, Nephrology, other medical specialties to be considered to staff Tier 1 depending on the need

Draft The learning and literature are changing frequently, and this document is not intended to replace best possible actions taken by competent authorities. These are general guidelines only. All safety, legal and regulatory requirements need to be considered Baptist Health Arkansas Coronavirus 2019 (COVID-19) CMO Medical Command Center

Baptist Health System – Medical staffing management for handling COVID – 19 Surge ICU Non staffing Resources 2 Telehealth Carts per unit Training considerations Physician Groups: Hospitalists, Cardiology, Nephrology, and all other physician groups Mandatory E-Training: Option 1 or 2 Critical Care for the Non-ICU Clinician Option 1 https://covid19.sccm.org/nonicu.htm Option 2 https://www.chestnet.org/Guidelines-and-Resources/COVID-19/On-Demand-e-Learning Non-Physician Groups: All ICU APNs and Med Surg APNs) Mandatory E-Training: Option 1 or 2 Critical Care for the Non-ICU Clinician Option 1 https://covid19.sccm.org/nonicu.htm Option 2 https://www.chestnet.org/Guidelines-and-Resources/COVID-19/On-Demand-e-Learning Mandatory Certification ACLS

Prepared by COVID 19 physician working group at Baptist Health System – Arkansas Chandra Lingisetty MD,MBA,MHCM, Eddie Phillips MD, Herbert Hahn MD, Anthony Bennett MD, Stanley Kellar MD, Jack Griebel MD, Andrea Choate MD Draft The learning and literature are changing frequently, and this document is not intended to replace best possible actions taken by competent authorities. These are general guidelines only. All safety, legal and regulatory requirements need to be considered