How do you plan for "what if"?
That was the challenge facing the Saskatchewan Health Authority (SHA) earlier this year. The COVID-19 pandemic was quickly spreading around the world and making inroads into the United States and Canada. It would surely come our way. When it did, how could we be ready?
At the time, a number of senior government and SHA leaders were putting the final touches on a general provincial pandemic plan. When the first case of COVID-19 was declared on March 12, the SHA’s planning machinery kicked into high gear.
Brent Kitchen, planning section chief for the SHA provincial emergency operations centre, said the key things he’s kept in mind since this process began is, “We need to have options, we need to be nimble and we need to work together.”
The SHA moved to a military “command and control” based reporting structure to speed decision-making, setting up incident command centres (ICCs) in North, Rural, Regina and Saskatoon which report into a provincial emergency operations centre.
Brent Kitchen studies a facility map in the Regina Integrated Health Incident Command Centre planning room at Regina Centre Crossing.
To provide a better understanding of what the province could be dealing with, a computational modelling team from the U of S with support from SHA’s Digital Health team used data from other jurisdictions to establish a worst-case scenario. It included numbers on how many people could become infected, how many may require acute care and intensive care and how many could die. These numbers were intended for planning purposes and were not predictions.
From this, acute care plans were created that looked at how the system could expand to create capacity while still ensuring the safety of and providing essential services for non-COVID-19 patients. These plans included information on how patients would flow through the system, whether field hospitals would be needed and which facilities would provide care for COVID-19 and non-COVID-19 patients.
Health System Readiness for COVID-19 plan was released to the public on April 8.
Meanwhile, the SHA established a labour pool which enables the organization to direct resources to areas of high need, created a process to contact all staff through their phones to support urgent communication needs, and built digital dashboards that provide detailed information on areas such as personal protective equipment (PPE) use and ventilator inventory.
Since the release of the initial acute care surge plan, Saskatchewan data shows that interventions such as social distancing and self-isolation have helped flatten the curve. The SHA began adjusting its acute care plans to reflect this.
In late April, SHA leaders mapped out scenarios and did simulations to fill in the plan details.
"We looked at when areas fill up, what our next step will be. The map looks like a waterfall of how units will expand for clinical and acute care," said Kitchen.
Acute care plans with triggers indicating when to expand and contract system capacity are now in place for every level of the system, right down to the unit level.
Similar planning is taking place in EMS, provincial programming and maternal and children's health.
Kitchen feels comfortable the system is as ready as it can be for a COVID-19 surge. "We can't plan for every scenario, but we feel we've plans in place for the big challenges.”
A major contributing factor to our current level of readiness, he said, has been that health care is provided across the province by one system. “It’s certainly reinforced the benefit of a single health authority.”
While some may even say the SHA has over-prepared, Kitchen is willing to accept this criticism. "People will judge us on what we don't do to prepare, not on what we did."