How to Use This Checklist

All staff responsible for preparing and operating an emergency surge expansion facility at a previously closed or partially closed hospital should inspect any candidate facility now. The Facility Checklist is intended to help with this inspection, by providing guidance to help determine each facility's strengths and weaknesses.

Using the Checklist will help insure that all aspects of each facility are inspected and all information is recorded. Most items on the Checklist would also apply to other types of facilities under consideration as a surge expansion hospital.

The Checklist is organized into the six areas of responsibility:

• Administration (ADMIN)
• Facilities (FAC)
• Medical Personnel (MED)
• Security (SEC)
• Supplies and Equipment (SUPPL)
• Medical Gas and Ventilation (GASV)

Each of the six tab-sections can be removed from the three-ring binder and given to the team member(s) with that responsibility. Team members can take their sections with them to inspect a candidate facility and use the spaces to record what they see.

Alternatively, the Checklist can be divided among team members according to the aspects of the facility in the subsections within each section. For example, one team member can inspect the facility's exterior, taking that subsection from each of the six areas of responsibility. Another can inspect advance patient care areas, etc. The subsections are identifiable by a title page and by the patterns of bars at the bottom of all pages of each subsection. Aspects of the facility include:

• Exterior.
• General Interior.
• Basement.
• Patient Care.
• Advanced Patient Care.
• Ancillary Services.
• Housekeeping and Food Service.

Note: If your team plans to inspect more than one facility, be sure that the Checklist has been photocopied or more than one Checklist has been ordered from AHRQ.

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Administration/ADMIN

Chief Administrator

The chief administrator is responsible for the strategic vision of the surge facility, so should take the time for a high level overview of the entire facility while allowing specialists to explore more technical aspects in detail. The chief administrator will:

• Explore the external site and neighborhood.
• Inspect the general facility.
• Visit both general and former advanced patient care areas.
• Determine the availability of office space and the other ancillary services.

Proceed to Administration checklists

Facilities/FAC

Facilities Experts

The facilities experts will tour most of the site and building with special attention to the operational status of systems such as HVAC, hot water, plumbing, cooling, electrical, and communications.

The facilities experts will:

• Thoroughly examine the internal and external building and identify usable areas.
• Tour the basement and other areas of the facility that include infrastructure, such as HVAC and hot water, to determine whether they are in working order or predetermine modifications for surge use.

Proceed to Facilities checklists

Medical/MED

Medical Personnel

The medical personnel are responsible for the ability to care for patients in the surge facility, so should take the time to consider patient safety, comfort, and quality of care, while allowing other experts to explore other facility aspects in more detail.

The medical personnel will:

• Briefly inspect several external parts of the facility.
• Inspect the general facility from the perspective of patient care.
• Visit both general and former advanced care areas for general surge use.
• Determine the possibility of opening support services such as labs and morgue.

Proceed to Medical checklists

Security/SEC

Security Experts

The security experts will inspect facility site and structure to access control, monitoring, and tracking of staff, patients, and visitors.

The security experts will:

• Explore the site and neighborhood to identify potential security and safety issues.
• Inspect site and building to ensure proper security standards, monitoring, and alarm systems are in place or can be installed.

Proceed to Security checklists

Supplies/SUPPL

Supplies and Equipment Experts

The supplies and equipment experts will tour the facility to determine if some necessary goods are already available and determine the storage and receiving capacity for additional supplies.

The supplies and equipment experts will:

• Examine external loading docks and access to facility.
• Review patient intake and reception areas for waiting area furniture. Tour patient care areas to determine needs, both material that must be removed and furniture that must be procured. Take inventory of available usable equipment and potential storage areas.
• Tour food preparation, laundry, and other service areas to determine if outsourcing will be needed.

Proceed to Supplies checklists

Gas and Ventilation/GASV

Medical Gas System Verifier

The medical gas system verifier will inspect the existing installed medical gas system in the proposed surge facility.

The medical gas system verifier will:

• Inspect the medical gas system components and lines and determine if usable or if cleaning and repairs are needed.
• Inspect medical gas outlets in patient care areas such as rooms, OR, and ICU.
• Determine whether portable gases should be used if centralized gases are not usable.

Proceed to Gas and Ventilation checklists

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