Abkhazia Institute for Social and Economic Research

Ramaz Mitaishvili, MD 

1. Review policies for scheduling elective procedures and develop guidelines and contingency plans to limit elective admissions and surgery. Decreasing elective utilization of health care facilities during a pandemic will increase bed availability, allow redistribution of staff and equipment, and may decrease the elective patient’s exposure to influenza infected persons. Consideration should be given to performing any necessary surgeries in a surgical ambulatory care center to reduce the likelihood of exposure to influenza infected patients in hospital.
   

1. Consider appointment of a triage officer to manage patient flow in the emergency department, including appropriate patient referral to other clinics within the facility or to local physicians' offices or nontraditional care settings when emergency department care is not required.
   
2. Review and revise criteria for admission. Consider directing patients referred for admission by their physician to the emergency department where the need for admission can be directly evaluated (by a triage officer) in the context of bed and staff shortages.
   
3. Review guidelines and policies allowing expeditious transfer of patients between units, especially from critical care units, when indicated.
4. Develop plans and policies to promptly transport discharged patients home or to other facilities. Consider creating a patient discharge holding area or discharge lounge to free up bed space.
5. Ensure that the facility has effective rules for expediting patient discharge during periods of anticipated high demand. These rules might include allocation of a sufficient number of triage physicians and nurses to the appropriate services and procedures for discharge and transfer of patients to home, or other facilities. Equipment/Supplies: Plan for the limited availability and increased need for equipment and supplies such as respirators, gurneys and supply carts within the facility and for potential disruption in the normal delivery of supplies and repair services. We would suggest to Abkhazian de-facto Government, as well as Georgian central Government include ventilators in a budget. Because a pandemic may not affect all areas simultaneously, it may be possible to shift some resources between areas; this may be most feasible if a pandemic wave already has passed through a community and ventilators become available rather than an area that has not yet experienced disease sending its equipment elsewhere. Consumable resource needs are those specific to an outbreak of infectious respiratory disease, including hand hygiene supplies, gowns, gloves, and surgical masks, as well as other supplies associated with routine patient care. Since these types of supplies have no expiration, it would be possible to establish stockpiles (either in individual facilities or regionally). In the event of a pandemic, local healthcare facilities will be the primary entity responsible for the treatment of ill persons, including dispensing antiviral medications.