June 6, 2020 Re: Hospital Preparedness During COVID-19 Dear Hospital Partners, As you know the Arizona Department of Health Services (ADHS) takes the threat of COVID-19 in Arizona very seriously and has taken aggressive action to ensure hospitals have adequate healthcare capacity and to educate Arizonans on mitigating the spread of this disease. We appreciate your partnership in responding to the pandemic and the work your facilities have done to date to expand bed capacity, coordinate across hospital systems, develop shared protocols, and support the success of the ​Arizona Surge Line​. Your facilities and staff are on the front line of this response and your continued ability to care for your patients in a safe manner is critical in Arizona’s success in overcoming COVID-19. For those reasons, I urge you to do or continue doing the following: ● Fully activate your facility emergency plan as directed by ​Executive Order 2020-16 ○ Institute your hospital incident command ○ Ensure continuation of essential service personnel, including non-clinical staff ○ Review the ​Arizona Crisis Standards of Care Plan​ to make determinations for moving your facility from conventional care to contingency care and prepare for crisis care ● Be judicious and reduce or suspend elective surgeries to ensure adequate bed capacity for both COVID and non-COVID admissions as required by ​Executive Order 2020-10 ○ Under ​Executive Order 2020-32​, facilities may request an exemption from Executive Order 2020-10 and resume elective surgeries if they can demonstrate several elements, including: ■ A 14 day supply of PPE; ■ Adequate staffing and bed availability with no more than 80% total bed capacity occupied; ■ Access to COVID-19 testing; and ■ Enhanced cleaning and screening precautions. ○ Facilities that have resumed elective surgeries but are now experiencing staffing shortages or inadequate bed capacity must suspend electives immediately ● Maintain and implement plans to staff the surge beds you identified as directed by Executive Order 2020-16 ○ Continue to identify additional ICU and inpatient beds to meet the 50% additional bed increase as required by Executive Order 2020-16. Douglas A. Ducey​ Governor ​Cara M. Christ, MD, MS​ Director    150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 ​P​ 602-542-1025 ​F​ 602-542-1062 Health and Wellness for all Arizonans ​W​ azhealth.gov  ○ ● ● ● ● ● ● Refine your hospital admission criteria to allow management of patients in alternate care settings within the community rather than within your facility ○ Evaluate discharge planning criteria and messaging to efficiently discharge patients not critically in need of ongoing inpatient acute care Institute plans to optimize staffing levels within your facility ○ Identify areas or positions where you can safely expand scope of practice and cross-train ○ Identify mechanisms to activate medical volunteers and integrate them into your facility, including coordination with your local public health department to explore volunteer staffing resources Fully participate in the ​Arizona Surge Line​ as directed by ​Executive Order 2020-38 ○ Utilize the Arizona Surge Line for interfacility transfer of patients with suspected or confirmed COVID-19 outside of your healthcare system ○ Accept and transfer patients as directed by the Surge Line, when clinically appropriate resources allow ○ Facilities with clinically appropriate resources and who have received an exemption from Executive Order 2020-10 from the Department must not decline an Arizona Surge Line transfer ■ Facilities should call their local public health department if current capacity requires them to hold resources for “local” patients or completion of an elective surgery Accurately report key hospital capacity data through EMResource as required under the Enhanced Surveillance Advisory​ issued by Governor Ducey on May 21, 2020 Evaluate your supplies and equipment and create facility guidance for optimization of scarce resources ○ Identify additional sources for supplies and equipment: training centers, outpatient facilities managed by your hospital system, ambulatory surgical centers, etc. ○ Institute CDC guidance for optimization of PPE: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html ○ Register​ for the ​Battelle Critical Care Decontamination System​ or implement a similar system in your facility for safe re-use of N95 masks if necessary Ensure efficient triage processes to relieve excess burden on your emergency room ○ Implement triage tents, triage hotlines, outpatient referral, and other alternate triage strategies outside the emergency department ○ Develop triage criteria for emergency care versus referral to an appropriate alternate location ○ Expand behavioral health case management capacity to reduce your number and duration of psychiatric holds Maintain communication with healthcare providers and public health within your region Douglas A. Ducey​ Governor ​Cara M. Christ, MD, MS​ Director    150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 ​P​ 602-542-1025 ​F​ 602-542-1062 Health and Wellness for all Arizonans ​W​ azhealth.gov  ○ Communicate resource needs with your public health partners who can facilitate resource acquisition, including staffing, through local, state, or federal partners if you have exhausted the options within your facility’s emergency plan We appreciate the partnership between your facilities and local and state public health in response to COVID-19. If your facilities are experiencing resource shortages (staffing, PPE, bed availability), please ensure you have notified your local public health department. If local public health is unable to fulfill your resource request, it is elevated to state public health and further elevated to federal partners if needed. Consistent communication and partnership will help us all work together to ensure we protect our residents. Thank you for your dedication to the people of Arizona and your tireless effort to keep our communities healthy. Sincerely, Cara Christ, MD Director Douglas A. Ducey​ Governor ​Cara M. Christ, MD, MS​ Director    150 North 18th Avenue, Suite 500, Phoenix, AZ 85007-3247 ​P​ 602-542-1025 ​F​ 602-542-1062 Health and Wellness for all Arizonans ​W​ azhealth.gov