VHA COVID-19 Operational Plan 1-27-2023.pdf

Veterans Health Administration COVID-19 Operational Plan

Version 1.5 – Last Updated 1/27/23

Contents

Document History Log

Executive Summary

Guiding Principles

Empowering Local Leadership

Maximizing Veteran Access and Minimizing Staff Burden

Internal and External Alignment

Communications

COVID-19 Health Protection Levels

Indicators

Low (Green) Level

Medium (Yellow) Level

High (Red) Level

Staffing

Document History Log

The VHA COVID-19 Operational Plan is a living document that will be updated to reflect new guidance and information. Any revisions to the Operational Plan will overwrite the baseline version.

The full list of previous updates can be found in the History Log.

Document Type (Baseline/Revision)

Document Revision

Effective Date

Description

Revision v1.5 1/27/2023

1. Added clarification regarding the community level metric in the indicators and included a footnote reference

2. Updated masking requirements for the green and yellow levels

3. Modified workplace restrictions in the red level to allow greater flexibility https://dvagov.sharepoint.com/:w:/r/sites/VHAIHPM/Future%20State%20Operational%20Plan%20Documents/VHA%20COVID-19%20Operational%20Plan/VHA%20COVID-19%20Operational%20Plan_History%20Log.docx

Executive Summary

The Veterans Health Administration (VHA) COVID-19 Operational Plan is iterative guidance providing the response framework and protocol for all VHA facilities to proactively navigate transition from pandemic to endemic operations.

Guiding Principles

Empowering Local Leadership Consistent with the High Reliability Organization principle of Sensitivity to Operations, Veterans Integrated Service Network (VISN) and facility leadership discretion should guide individualized application of this guidance to meet unique local circumstances and needs (e.g., clinic-level differences, facility constraints, staffing shortages, or community outbreaks). Local leaders are best informed of and able to proactively manage their capacity and demand for in-house and community care. VHA Central Office clinical and operational leadership supports and empowers local leadership, informed by this plan, to make the right decisions to ensure Veterans receive timely, clinically appropriate care.

Maximizing Veteran Access and Minimizing Staff Burden The Operational Plan establishes a framework for facilities to continue providing Veterans with maximum access to safe, timely, high-quality care despite increases or decreases in COVID-19 conditions and evolving variants. Facilities should use this guidance to prioritize Veteran and employee safety and offer a full spectrum of flexible care options to meet Veterans’ needs. Facilities should promote and sustain employee resiliency and minimize changes in working conditions as much as practical to meet the needs of COVID-19 conditions.

Internal and External Alignment

The Operational Plan provides general guidance for VHA facilities. As with discretion given VISN and facility leadership to tailor the guidance to meet local circumstances, VHA Program Offices may continue to provide their own guidance to navigate program- or service-specific needs (e.g., CLC Moving Forward Plan, RRTP Moving Forward, Inpatient Mental Health).

The Operational Plan is in alignment with the White House’s National COVID-19 Preparedness Plan;

and COVID-19 recommendations from Federal partners, including the Centers for Disease Control and Prevention (CDC), Occupational Safety and Health Administration (OSHA), and Safer Federal Workforce Task Force. VHA’s COVID-19 Health Protection Levels include measures that are appropriate for a health care setting. Actions associated with the COVID-19 Health Protection Levels reflect the operational considerations associated with guidance for a single large, coordinated national health care system, which may differ from the considerations governing guidance to a diverse population of health care providers or to the general public.

Communications

A key objective of the Operational Plan is to empower staff at all levels of the organization—through clear, consistent, streamlined messaging supporting understanding of recommended protocol—to provide a safe, welcoming environment for Veterans. Updated communication materials, messaging, and frequently asked questions can be found in the Operational Plan Communications Materials folder.

https://dvagov.sharepoint.com/sites/VACOVHAPublicHealth/HCI/Moving%20Forward/CLC%20Moving%20Forward%20Plan/CLC%20Moving%20Forward%20Plan.pdf https://dvagov.sharepoint.com/sites/VACOVHAPublicHealth/HCI/Moving%20Forward/CLC%20Moving%20Forward%20Plan/CLC%20Moving%20Forward%20Plan.pdf https://dvagov.sharepoint.com/sites/VACOMentalHealth/mhrrtp/COVID19/Forms/AllItems.aspx?RootFolder=%2Fsites%2FVACOMentalHealth%2Fmhrrtp%2FCOVID19%2FMH%20RRTP%20MOVING%20FORWARD%20DOCUMENTS&FolderCTID=0x012000C368E08E8EB68D4BB3CFE1D84475243B https://dvagov.sharepoint.com/sites/VACOVHAPublicHealth/HCI/Moving%20Forward/Inpatient%20Mental%20Health%20Units https://www.whitehouse.gov/covidplan/ https://www.cdc.gov/coronavirus/2019-ncov/index.html https://www.cdc.gov/coronavirus/2019-ncov/index.html https://www.osha.gov/coronavirus/ https://www.saferfederalworkforce.gov/overview/ https://www.saferfederalworkforce.gov/overview/ https://dvagov.sharepoint.com/sites/VHAIHPM/SitePages/Future-State-Operational-Plan.aspx https://dvagov.sharepoint.com/:f:/r/sites/VHAIHPM/Future%20State%20Operational%20Plan%20Documents/VHA%20COVID-19%20Operational%20Plan%20Communications%20Materials?csf=1&web=1&e=KPrjos https://dvagov.sharepoint.com/:f:/r/sites/VHAIHPM/Future%20State%20Operational%20Plan%20Documents/VHA%20COVID-19%20Operational%20Plan%20Communications%20Materials?csf=1&web=1&e=KPrjos

COVID-19 Health Protection Levels

Indicators

VHA’s green (low), yellow (medium), and red (high) response levels correspond with CDC’s Level of Community Transmission.1 VHA COVID-19 Health Protection Levels will ensure patient and employee safety in VHA health care settings.2 Local leadership has discretion to define which spaces are considered health care settings.3 The levels provide guidance for managing general operations and care for non-COVID patients; thus, operational levels should not impact clinical decision-making specific to COVID-positive, symptomatic, or exposed patients.

The COVID-19 Community Level Metric is different from the Community Transmission metric which is used in this operational plan. Community Transmission refers to measures of the presence and spread of SARS-CoV-2, the virus that causes COVID-19. COVID-19 Community Levels refer to the measures of the impact of COVID-19 in terms of hospitalizations and healthcare system strain, while accounting for transmission in the community. Healthcare settings predominantly align with Community Transmission levels4

The VHA COVID-19 Health Protection Level Tool, housed on the VA COVID-19 National Surveillance Tool, displays timely indicators to support local decisions on VHA COVID-19 Health Protection Levels and enables VHA leadership visiblity of enterprise-wide snapshot and historical facility status. The process for determining, monitoring, and reporting facility levels is found in Appendix A.

1 If the two indicators suggest different transmission levels, the higher level is selected.

2 This guidance applies to healthcare settings. For non-healthcare settings, reference Frequently Asked Questions | Safer Federal Workforce and VHA memo on masking and screening testing.

3 Generally, healthcare settings in VHA are considered locations where healthcare services or healthcare support services are provided to patients or residents (e.g., hospitals, Community Living Centers)..

4 Science Brief: Indicators for Monitoring COVID-19 Community Levels and Making Public Health Recommendations | CDC https://covid.cdc.gov/covid-data-tracker/#county-view?list_select_state=all_states&list_select_county=all_counties&data-type=Risk&null=Risk https://covid.cdc.gov/covid-data-tracker/#county-view?list_select_state=all_states&list_select_county=all_counties&data-type=Risk&null=Risk https://www.cdc.gov/coronavirus/2019-ncov/your-health/covid-by-county.html https://app.powerbigov.us/groups/me/apps/7e7bb69f-e353-4bbd-8a73-6ceea7639079/reports/8c39adf7-1ebb-4296-a3fb-71638d368a15/ReportSection?ctid=e95f1b23-abaf-45ee-821d-b7ab251ab3bf https://app.powerbigov.us/groups/me/apps/7e7bb69f-e353-4bbd-8a73-6ceea7639079/reports/b8b81c30-02f2-4ecf-bfa9-37e94c748a64/ReportSection3dd692a49dd2b508b812?ctid=e95f1b23-abaf-45ee-821d-b7ab251ab3bf https://app.powerbigov.us/groups/me/apps/7e7bb69f-e353-4bbd-8a73-6ceea7639079/reports/b8b81c30-02f2-4ecf-bfa9-37e94c748a64/ReportSection3dd692a49dd2b508b812?ctid=e95f1b23-abaf-45ee-821d-b7ab251ab3bf https://dvagov.sharepoint.com/:w:/r/sites/VHAIHPM/Future%20State%20Operational%20Plan%20Documents/VHA%20COVID-19%20Operational%20Plan/VHA%20COVID-19%20Operational%20Plan_Appendix%20A.docx https://www.saferfederalworkforce.gov/faq/ https://www.saferfederalworkforce.gov/faq/ https://dvagov.sharepoint.com/sites/VACOVHAPublicHealth/HCI/Administration/DUSHOM%20Guidance/030822--Veterans%20Health%20Administration%20(VHA)%20Masking%20and%20Screening%20Testing%20Guidance%20for%20Healthcare%20Settings.pdf https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/indicators-monitoring-community-levels.html#:~:text=Community%20Transmission%20refers%20to%20measures%20of%20the%20presence,transmission%20in%20the%20community.%20COVID-19%20Community%20Level%20Indicators

Category Low (Green) Level: Operational Guidance

Care Balancing

• Routine care is provided with no restrictions related to COVID-19 Routinely identify, in return to clinic orders and in Consult Toolbox, future visits, consults, and referrals clinically appropriate to be conducted through telehealth.

• Routinely offer patients the option of receiving their care by virtual modalities where clinically appropriate.

• No COVID-19 restrictions for in-person group care (wellness, therapy, and/or treatment).

Encourage in-person group care in inpatient mental health, RRTP, and domiciliaries. Use existing “pods” or groups for residential settings, where appropriate.

Masking &

PPE

• Enforce universal masking for all patients, staff, and visitors in areas of the healthcare facility where patients could be encountered.2F

• Facilities could choose not to require universal masking in well-defined areas that are restricted from patient access such as engineering, finance offices, HR offices, staff meeting rooms that are not located within clinical areas

• Facilities may also choose not to require universal masking in low-risk public areas of buildings such as atriums or hallways following an individualized risk assessment.67

• Provide masks to all patients, staff, and visitors.

• Provide N95 respirators to all staff on a voluntary basis under the Mini Respiratory Protection Program. Care for COVID-19 patients requires use of N95 or above (29 CFR 1910.134).

• Provide appropriate PPE to staff, optimizing supply as needed.

• Use visual cues (signage, message boards) to explain masking requirements.

• Infection Control Guidance for Healthcare Professionals about COVID-19 | CDC8

Entry Screening

• Use passive3F

9 self-screening.

• Taking temperature is not required.

Physical Distancing

• Allow <6 feet physical distancing to improve patient access and/or alleviate staff burden.

• Consider cell phone/parking lot waiting option.

Visitors • VHA COVID-19 Visitation Quick Guide

Testing • COVID-19 Testing Guidebook

Workplace

• Allow indoor in-person meetings.

• Allow shared meals and gatherings. No restrictions on outdoor gatherings.

• Maintain equipment and skills for staff to telework.

• Follow travel restrictions4F

10: Safer Federal Workforce Travel FAQs

• COVID-19: VA's Workplace Re-Entry Guidance

• Protecting the Federal Workforce During the COVID-19 Pandemic | SFW

Ventilation

• OSHA Ventilation

• CDC Ventilation (for healthcare setting); CDC Ventilation in Buildings (for non-patient care areas)

Cleaning & Disinfection

• HEFP COVID Cleaning Matrix

5 Exceptions when: (1) in non-healthcare settings; (2) outdoors; (3) alone in room; (4) eating or drinking; (5) wearing respiratory protection; (6) important to see a person’s mouth; (7) cannot wear for medical reasons (reasonable accommodation); (8) could cause serious injury or death.

6 Masking is still required for individuals with suspected or confirmed SARS-CoV-2 infection or other respiratory infection, or respiratory symptoms even if mild; individuals who have had close contact or a higher risk exposure to someone with SARS-CoV-2 infection in the previous 10 days, in units or areas experiencing outbreaks, and HCP who have not received their annual influenza vaccine, during influenza season.

7 Individuals might also choose to continue using source control based on personal preference, informed by their perceived level of risk for infection based on their recent activities (e.g., attending crowded indoor gatherings with poor ventilation) and their potential for developing severe disease.

8 Non-recordkeeping portions of OSHA Emergency Temporary Standard rescinded but remain relevant as guidance.

9 Passive screening: patients, staff, and visitors self-assess using standard list of questions on poster and/or online list. Consider benefits of active in-person entry monitoring where feasible: symptom screening/routing, visitor control, wayfinding, and masking compliance (education, distribution, provision).

10 Continue to follow specific clinical or support travel guidance (e.g., DEMPS, Travel Nurse Corps, Clinical Deployment Teams).

https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.504 https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.504 https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134 https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html https://dvagov.sharepoint.com/:b:/r/sites/VHAIHPM/Future%20State%20Operational%20Plan%20Documents/VHA%20COVID-19%20Operational%20Plan/VHA%20Visitation%20Quick%20Guide.pdf https://dvagov.sharepoint.com/sites/VACOVHAPublicHealth/HCI/Screening%20Diagnosis%20%20Treatment/Testing/COVID-19_Testing_Clinical_Guidebook.pdf https://www.saferfederalworkforce.gov/faq/travel https://dvagov.sharepoint.com/sites/OCHCOHRERC https://www.saferfederalworkforce.gov/overview/ https://www.osha.gov/sites/default/files/publications/OSHA4103.pdf https://www.osha.gov/sites/default/files/publications/OSHA4103.pdf https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html https://dvagov.sharepoint.com/sites/VACOVHAPublicHealth/HCI/Infection%20Control/Cleaning%20Matrix%20Rev%202-23-22.pdf https://dvagov.sharepoint.com/sites/VACOVHAPublicHealth/HCI/Administration/DUSHOM%20Guidance/011022%20--%20Guidance%20for%20Prioritization%20of%20Disaster%20Emergency%20Management%20Personnel%20System%20Deployers.pdf?CT=1651517087560&OR=Outlook-Body&CID=0B2B38FA-B69D-4976-B34B-2E78FD15281D https://vaww.va.gov/nursing/tnc.asp

Category Medium (Yellow) Level: Operational Guidance

Balancing

• Routine care is provided with no restrictions related to COVID-19.

• Routinely identify, in return to clinic orders and in Consult Toolbox, future visits, consults, and referrals clinically appropriate to be conducted through telehealth.

• Routinely offer patients the option of receiving their care by virtual modalities where clinically appropriate.

• No COVID-19 restrictions for in-person group care (wellness, therapy, and/or treatment).

Encourage in-person group care in inpatient mental health, RRTP, and domiciliaries. Use existing “pods” or groups for residential settings, where appropriate.

Masking &

PPE

• Enforce universal masking for all patients, staff, and visitors in areas of the healthcare facility where patients could be encountered.6F

• Facilities could choose not to require universal masking in in well-defined areas that are restricted from patient access such as engineering, finance offices, HR offices, staff meeting rooms that are not located within clinical areas.

• Provide masks to all patients, staff, and visitors.

• Provide N95 respirators to all staff on a voluntary basis under the Mini Respiratory Protection Program. Care for COVID-19 patients requires use of N95 or above (29 CFR 1910.134).

• Provide appropriate PPE to staff, optimizing supply as needed.12

• Use visual cues (signage, message boards) to explain masking requirements.

• Infection Control Guidance for Healthcare Professionals about COVID-19 | CDC

• OSHA Emergency Temporary Standard13

Entry Screening

• Consider active screening at discretion of local leadership. Otherwise, allow passive14 7F screening.

• Taking temperature is not required.

Physical Distancing

• Allow <6 feet physical distancing to improve patient access and/or alleviate staff burden.

• Consider cell phone/parking lot waiting option.

Visitors • VHA COVID-19 Visitation Quick Guide

Testing • COVID-19 Testing Guidebook

Workplace

• Allow indoor in-person meetings.

• Allow shared meals and gatherings. Stagger mealtimes. No restrictions on outdoor gatherings.

• Maintain equipment and skills for staff to telework.

• Follow travel restrictions4F

15: Safer Federal Workforce Travel FAQs

• COVID-19: VA's Workplace Re-Entry Guidance

• Protecting the Federal Workforce During the COVID-19 Pandemic | SFW

Ventilation

• OSHA Ventilation

• CDC Ventilation (for healthcare setting); CDC Ventilation in Buildings (for non-patient care areas)

11 Exceptions when: (1) in non-healthcare settings; (2) outdoors; (3) alone in room; (4) eating or drinking; (5) wearing respiratory protection; (6) important to see a person’s mouth; (7) cannot wear for medical reasons (reasonable accommodation); (8) could cause serious injury or death.

12 Use eye protection and N95 respirator or higher for aerosol-generating procedures.

13 Non-recordkeeping portions of OSHA Emergency Temporary Standard rescinded but remain relevant as guidance.

14 Passive screening: patients, staff, and visitors self-assess using standard list of questions on poster and/or online list. Consider benefits of active in-person entry monitoring where feasible: symptom screening/routing, visitor control, wayfinding, and masking compliance (education, distribution, provision).

15 Continue to follow specific clinical or support travel guidance (e.g., DEMPS, Travel Nurse Corps, Clinical Deployment Teams).

https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.504 https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.504 https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134 https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html https://www.osha.gov/sites/default/files/covid-19-healthcare-ets-reg-text.pdf https://dvagov.sharepoint.com/:b:/r/sites/VHAIHPM/Future%20State%20Operational%20Plan%20Documents/VHA%20COVID-19%20Operational%20Plan/VHA%20Visitation%20Quick%20Guide.pdf https://dvagov.sharepoint.com/sites/VACOVHAPublicHealth/HCI/Screening%20Diagnosis%20%20Treatment/Testing/COVID-19_Testing_Clinical_Guidebook.pdf https://www.saferfederalworkforce.gov/faq/travel https://dvagov.sharepoint.com/sites/OCHCOHRERC https://www.saferfederalworkforce.gov/overview/ https://www.osha.gov/sites/default/files/publications/OSHA4103.pdf https://www.osha.gov/sites/default/files/publications/OSHA4103.pdf https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html https://dvagov.sharepoint.com/sites/VACOVHAPublicHealth/HCI/Administration/DUSHOM%20Guidance/011022%20--%20Guidance%20for%20Prioritization%20of%20Disaster%20Emergency%20Management%20Personnel%20System%20Deployers.pdf?CT=1651517087560&OR=Outlook-Body&CID=0B2B38FA-B69D-4976-B34B-2E78FD15281D https://vaww.va.gov/nursing/tnc.asp

Category High (Red) Level: Operational Guidance

Balancing

• Use virtual appointments over in-person appointments where clinically appropriate.

• Consider temporary reduction of services in inpatient surgery, inpatient admissions, outpatient procedural, and non-CLC residential care, only once contingency staffing strategies have been fully implemented.

• Allow, with appropriate protections in place, in-person group care in inpatient mental health, RRTP, and domiciliaries, as well as limited outpatient groups. Consider Veteran preferences, clinical benefit, and infection risk when determining modality for group offerings. Continue to use existing “pods” or groups for residential settings.

• Avoid cancelling appointments. Reschedule only if no alternative options.

• Routinely identify, in return to clinic orders and in Consult Toolbox, future visits, consults, and referrals clinically appropriate to be conducted through telehealth.

Masking &

PPE

• Enforce universal masking for all patients, staff, and visitors in all areas of the healthcare facility.9F

• Provide masks to all patients, staff, and visitors.

• Provide N95 respirators to all staff on a voluntary basis under the Mini Respiratory Protection Program. Care for COVID-19 patients requires use of N95 or above (29 CFR 1910.134).

• Follow CDC recommendations for use of NIOSH-approved N95 or equivalent or higher-level respirators for selected or all patient care encounters.

• Provide appropriate PPE to staff, optimizing supply as needed.

• Use visual cues (signage, message boards) to explain masking requirements.

• Infection Control Guidance for Healthcare Professionals about COVID-19 | CDC

• OSHA Emergency Temporary Standard17

Entry Screening

• Consider active screening at discretion of local leadership. Otherwise, allow passive18 7F screening.

• Taking temperature is not required.

Physical Distancing

• Implement ≥6 feet physical distancing where practicable.

• Consider cell phone/parking lot waiting option.

Visitors • VHA COVID-19 Visitation Quick Guide

Testing • COVID-19 Testing Guidebook

Workplace

• Restrict indoor in person meetings unless mission critical. Consider moving meetings to non-healthcare buildings. Restrict shared meals and gatherings. Stagger mealtimes. No restrictions on outdoor gatherings. Maximize workplace flexibilities (i.e., telework where it does not impact operations).

• Obtain USH approval for meetings >50 people.

• Follow travel restrictions: Safer Federal Workforce Travel FAQs

• COVID-19: VA's Workplace Re-Entry Guidance

• Protecting the Federal Workforce During the COVID-19 Pandemic | SFW

Ventilation

• OSHA Ventilation

• CDC Ventilation (for healthcare setting); CDC Ventilation in Buildings (for non-patient care areas)

Cleaning & Disinfection

• HEFP COVID Cleaning Matrix

16 Exceptions when: (2) outdoors; (3) alone in room; (4) eating or drinking; (5) wearing respiratory protection; (6) important to see a person’s mouth; (7) cannot wear for medical reasons (reasonable accommodation); (8) could cause serious injury or death.

17 Non-recordkeeping portions of OSHA Emergency Temporary Standard rescinded but remain relevant as guidance.

18 Passive screening: patients, staff, and visitors self-assess using standard list of questions on poster and/or online list. Consider benefits of active in-person entry monitoring where feasible: symptom screening/routing, visitor control, wayfinding, and masking compliance (education, distribution, provision).

https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.504 https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.504 https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134 https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html https://www.osha.gov/sites/default/files/covid-19-healthcare-ets-reg-text.pdf https://dvagov.sharepoint.com/:b:/r/sites/VHAIHPM/Future%20State%20Operational%20Plan%20Documents/VHA%20COVID-19%20Operational%20Plan/VHA%20Visitation%20Quick%20Guide.pdf https://dvagov.sharepoint.com/sites/VACOVHAPublicHealth/HCI/Screening%20Diagnosis%20%20Treatment/Testing/COVID-19_Testing_Clinical_Guidebook.pdf https://www.saferfederalworkforce.gov/faq/travel https://dvagov.sharepoint.com/sites/OCHCOHRERC https://www.saferfederalworkforce.gov/overview/ https://www.osha.gov/sites/default/files/publications/OSHA4103.pdf https://www.osha.gov/sites/default/files/publications/OSHA4103.pdf https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html https://dvagov.sharepoint.com/sites/VACOVHAPublicHealth/HCI/Infection%20Control/Cleaning%20Matrix%20Rev%202-23-22.pdf

Staffing

Staffing strategies are not based on COVID-19 Health Protection Levels but on Conventional, Contingency, and Crisis staffing per Strategies to Mitigate Healthcare Personnel Staffing Shortages | CDC. Contingency or

Crisis staffing may be implemented, with facility leadership approval, in a targeted fashion (e.g., if a single workgroup or clinic is impacted to an extent that degrades its ability to support a critical facility mission, Contingency or Crisis staffing may be implemented for that workgroup or clinic).

Conventional

• Utilize standard regulation and policy requirements for workforce recruitment and retention strategies.

Contingency

• Implement targeted workforce recruitment and retention strategies/flexibilities to address staffing and/or access concerns in specified markets.

• Activate Clinical Deployment Teams (CDTs). 5F

Crisis

• Activate DEMPS.

• Implement contract for additional staff.

• Implement all workforce recruitment and retention strategies/flexibilities to address staffing and/or access concerns in specified markets or VHA-wide.

• Activate Clinical Deployment Teams (CDTs).

19 Clinical Deployment Teams: 20 FTE per VISN currently being planned and implemented by a VHA Central Office-level workgroup. Target date: Q4 FY23.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html