Bioterrorism Hospital Preparedness Program: HRSA Work Plan
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Bioterrorism Hospital Preparedness Program: HRSA Work Plan |
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Summary of Priority Area 4-A
Summary of Priority Area 4-B
Summary of Priority Area 4A description of proposed mechanisms to build upon or put in place a coordinated system to provide seamless hospital laboratory services in response to state public health needs in efforts led by the public health departments. Priority Area 4-A: Hospital Laboratories During the 2003-04 Bioterrorism Grant period, the Washington State Public Health Laboratories (WAPHL) proposes to carry out the following improvements related to cross-cutting activities (biological and chemical):
Critical Benchmark 4-1 Strategies: What overarching approach(es) will be used to undertake this activity?
1a. Continuation of year 1 training program to teach hospital laboratories to “Rule out or Refer” possible bioterrorism-related clinical specimens. 1b. Provide HRSA funding to support expenses associated with bioterrorism-related (biological, chemical and radiological) training. This includes training available at the PHL. 1c. Provide HRSA funding to hospitals in support of expenses associated with hospital proficiency testing for bioterrorism 1d. Continue with year 1 plans to establish lines of communication with hospital laboratories and local veterinary hospitals/laboratories through site visits and regional meetings, broadcast faxes, newsletters and internet sites. 1e. Continue year 1 plan to develop and maintain point-of-contact information with hospital laboratories. 1f. Continue year 1 plan to provide guidance for safe laboratory practices, quality control and quality assurance, and the adequacy of staffing and training in hospital laboratories
1g. Continue year 1 plan to train hospital laboratories on the
appropriate referral of test specimens by conducting workshops and
educational seminars. 1h, Continue with year 1 plans to assist in providing advanced diagnostic capabilities for agents of bioterrorism to select hospital laboratories (i.e., UW diagnosis of smallpox using EM digital imaging) 1i. Provide HRSA funding to support expenses associated with completion of PHL survey of analytical laboratories (Link with Critical Capacity #8) 1j. Provide HRSA funding to purchase Class II biological safety cabinets to hospitals where needed.
2a. Collaboration with Laboratory Quality Assurance (LQA) in maintaining list (database) 2b. Ensure list (database) is complete and that
it contains all necessary fields 3a. Continue year 1 plan for expansion of the training of hospital and Level B laboratories for handling forensic specimens using chain of custody. 3b. Continuation year 1 plan of training program to teach hospital laboratories to safely transport clinical specimens using current DOT and IATA regulations. 3c. Continue to develop year 1 plan to participate in simulation exercises set up with first responders, hospital laboratories, other LRN laboratories and the state EOC. 3d. Develop and distribute reference materials to be used by hospitals and Level B laboratories.
4a. Continue with year 1 plan for maintenance and upgrade of a database of hospital and Level B laboratories to monitor roles, responsibilities and capacities. 4b. Continue year 1 plan to develop in-depth wet workshops for hospital laboratories 4c. Include ability to refer to BSL-4 federal laboratory facilities at CDC and USAMRIID 4d. Maintain documentation that LRN
trained hospital laboratories are willing to participate in the
testing of clinical specimens associated with bioterrorism. 5a. Continue year 1 plan for hospitals to acquire equipment to communicate more effectively with hospital laboratories and other LRN members. 5b. Collaborate with LQA to expand and maintain the PHL hospital laboratory database to include current e-mail, phone and fax numbers of hospital laboratories (document that faxes are in a secure location in hospital laboratories). 5c. Ensure that the PHL database of hospital laboratories keeps and maintains the name of a 24/7 contact at the hospital laboratory (Supervisor/Director)
6a. Continuation of year 1 plans for development of surge capacity to include other state public health labs and Level B support within the state. The proposal includes training of hospital laboratories in the implementation of surge capacity plans. 6b. Expand year 1 plan for coordination of the process of referral of blood and urine specimens to CDC, or to a CDC supported laboratory, for analysis of chemical agents. Protocols will be consistent with CDC procedures. 6c. Expand year 1 plans to coordinate with the Clinical Laboratory Advisory Council (CLAC) in the development of guidelines for managing bioterrorism events. 6d. Work with CLAC to establish a bioterrorism committee that can be used to address questions and concerns among the laboratory community.
6e.
Provide HRSA funding to hospital laboratories for purchase of sample
shipping containers that meet current standards (i.e., DOT and IATA). 7a. Complete year 1 plan for acquisition of a satellite downlink for WAPHL (Link to Focus Area G).
8a. Continue year 1 plan to publish ELaborations as a means of updating the laboratory community on BT issues. 8b. As a follow-up to year 1 plans, update and distribute a list of professional organizations and other laboratory groups in Washington State for distribution among hospital laboratories and other LRN members. 8c.
Continue year 1 plan to bring together hospital laboratory
practitioners, university laboratories and infectious disease
physicians, as well as state and local public health laboratory
practitioners in the design and execution of studies to assess and
improve LRN laboratories. 9a. Allow ordering of tests using a web-based interface 9b. Allow hospitals to query the PHL LIMS for test results through a secure access. 9c. Allow electronic reporting of test results by the PHL 9d. Allow hospitals to order test kits from the PHL using a web-based interface. 9e. Allow for billing for laboratory services when appropriate 9f. Allow hospitals to request/sign-up for training on-line. 9g. Allow rapid and efficient mutual assistance (surge capacity) between reference laboratories 9h. Ensure PHL LIMS development includes adherence to national standards (e.g., LOINC)
Timeline: What are the critical milestones and
completion dates for each task?
Responsible Parties: Identify the person(s) and/or entity assigned to complete each task. 1a. LPA 1b. LPA 1c. Micro OD 1d PHL Director 1e. Training Manager 1f. Training Manager 1g. LPA 1h. PHL Director 1i. Operations Manager 1j PHL Director
2a. Training Manager 2b. Training Manager
3a. LPA 3b. LPA 3c. Div ERP 3d. Training Manager
4a. Training Manager 4b. Training Manager 4c. LPA 4d. BT Coordinator
5a. LIMS Coordinator 5b. Training Manager 5c. Training Manager
6a. 8/04 6b-6d. 12/03 6e. 11/03
7a. 8/04
8a. Ongoing 8b. 12/03 8c. 8/04 9a-9h Ongoing
Evaluation Metric: How will the agency determine progress toward Washington State successful completion of the overall recipient activity?
1a. Training Schedule 1b. Travel Documents 1c. Proficiency results 1d Meeting notes, etc 1e. Point-of-contact list 1f. Guidance documentation 1g. Training schedule 1h. Purchase orders and MOU 1i. Completed survey 1j. Purchase orders
2a. Completed database 2b. Database field list
3a. Training plan 3b. Training schedule 3c. Exercise plan 3d. Reference materials
4a. Updated database 4b. Training plan 4c. Procedures 4d. Signed Documentation
5a. Purchase orders 5b. Database 5c. Updated database
6a. MOUs and consolidated contracts 6b. Process and training documentation 6c. Meeting notes and guidelines 6d. Committee minutes 6e. Purchase orders
7a. Project documentation
8a. Publications 8b. Updated list 8c. Meeting minutes
9a. Operational web interface 9b. Operational query 9c. Electronic reporting 9d. Electronic test ordering 9e. Electronic billing 9f. On-line training registration 9g. Inter-state electronic test reporting 9h. LIMS requirements document
Priority Area 4 B: Surveillance and Patient TrackingThe purpose of this priority area is to expand both rural and urban surveillance efforts at the hospital, outpatient and pre-hospital levels, in coordination with what is being accomplished through the CDC terrorism cooperative agreement at the public health department level.
Enhance the capability of rural and urban hospitals, clinics, emergency medical services systems and poison control centers to report syndromic and diagnostic data that is suggestive of terrorism to their associated local and state health departments on a 24-hour-a-day, 7-day-a-week basis.
Strategies: What overarching approach (es) will
be used to undertake this activity? Healthcare facilities in Washington State are required to report notifiable conditions, including diseases of suspected bioterrorism origin, according to guidelines in Washington Administrative Code (WAC) 46-101. Working closely with local public health agencies and public health preparedness regions in Washington State, hospitals will document policies and procedures for notifiable condition reporting in accordance with WAC 246-101. These procedures should include specific LHJ telephone and fax numbers for notifiable condition reporting, timeframes, criteria for reporting, and staff responsible for these tasks. As these policies and procedures are being developed, the focus should rest on immediately notifiable conditions and disease syndromes or clusters that may indicate terrorism. Hospital staff identified with responsibilities for reporting should be trained on the policies and procedures by, or in conjunction with, local public health agencies. Local health jurisdictions and/or public health regions must ensure that healthcare facilities have access to appropriate resources for notifiable condition reporting, including but not limited to, notifiable conditions posters, websites, guidelines for surveillance and reporting, and newsletters or other communication mechanisms documenting the number and type of conditions reported. Healthcare facilities will begin to develop technology infrastructure to support electronic data interchange with a variety of partners. The State Department of Health (DOH) will guide these efforts by providing standards built on the Public Health Information Network (PHIN) and other national standards as appropriate, as well as lessons learned from existing systems which support electronic data interchange between hospitals and public health agencies (i.e., electronic laboratory-based reporting and syndromic surveillance demonstration projects). As healthcare facilities develop the capacity to generate electronic messages according to national standards, through modification of existing information systems or implementation of new systems, DOH will provide the functional requirements necessary for sending electronic messages to the public health system. These activities are consistent with ongoing work to allow clinical and hospital laboratories to electronically generate and send notifiable condition reports to public health agencies (see CDC Critical Capacity 5, Activity 12 for further description) and will initiate and inform efforts in future years to build systems for reporting notifiable conditions electronically to local and state public health agencies. Develop a pilot, web-based, secure reporting system for health care providers that would receive both diagnostic and syndromic case reports. Identify a Local Public Health Region that will use existing NEDSS/WEDSS data security and infrastructure standards in close collaboration with the Washington State DOH WEDSS program to pilot the development of the web-based reporting system. The pilot region will consult with local hospitals and key reporters regarding web site design and content. Content of web site might include comprehensive information on surveillance for clinicians including notifiable condition reporting requirements and procedures, case definitions, laboratory testing, infection control and exposure management considerations, etc. An electronic data interface has been established from the Washington State Poison Control Center for the purposes of providing data to the DOH Pesticide Poisoning Program. State and Regional Focus Area B Surveillance Coordinators will explore the utility of this data for syndromic surveillance indicators of potential bioterrorism or disease outbreaks. Tasks: What key tasks will be conducted in carrying out each identified strategy? 1. Identify current hospital staff to serve as a surveillance liaison with local public health jurisdiction concerning notifiable condition reporting and other surveillance activities; including provision of centralized email for dissemination of important public health alerts. 2. Develop policies and procedures for reporting notifiable conditions, particularly immediately notifiable conditions and syndromes or clusters that may indicate bioterrorism. 3. Ensure inclusion of expectations for making progress toward Washington State capability to generate electronic messages in standard format as part of HRSA contract with hospitals 4a. Identify a Local Public Health Region interested in developing a pilot web-based, secure reporting system for health care providers 4b. Develop a model for authenticating providers and collecting notifiable and syndromic disease reports electronically. 4c. Develop a secure web site to host content describing notifiable conditions and reporting criteria. (e.g., what conditions are reportable, whom to report to, when to report, what to report, what specimens to submit, who to submit specimens to, etc.). 4d. Develop a strategy for maintaining access control and password information for providers to allow them to submit disease reports electronically. 4e. Develop the ability to receive reports of notifiable conditions electronically via web-based reporting. 4f. Evaluate the usefulness of the web-based system for receiving notifiable condition and syndromic reports 5a. Obtain data on a daily basis from Washington State Poison Control Center (via TransAct Washington State) 5b. Explore utility of the Washington State Poison Control Center for syndromic surveillance.
Timeline: What are the critical milestones and
completion dates for each task?
Responsible Parties: Identify the person(s) and/or entity assigned to complete each task. 1. Hospitals, regional surveillance coordinators and/or local communicable disease staff 2. Hospitals, regional surveillance coordinators and/or local communicable disease staff 3. WEDSS and HRSA lead 4a. Focus Area B Lead, WEDSS and HRSA lead 4b. Identified LHJ Regional Lead, WEDSS 4c. Identified LHJ Regional Lead, WEDSS, Focus Area B 4d. Identified LHJ Regional Lead, WEDSS 4e. Identified LHJ Regional Lead, WEDSS, Focus Area B, Focus Area G 4f. Identified LHJ Regional Lead, WEDSS 5a. State Surveillance Coordinator 5b. State and Regional Surveillance Coordinators Evaluation Metric: How will the agency determine progress toward Washington State successful completion of the overall recipient activity?
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