Presentation Transcript

1. “Surviving Sandy: Hospitals Make the Best Out of a Terrible Situation” Annual Membership Meeting - American Hospital Association Monday, April 29, 2013 Arthur A. Gianelli, MA, MBA, MPH President and Chief Executive Officer of the NuHealth System
2. NuHealth in a Nutshell NuHealth is a public benefit corporation that operates: The Nassau University Medical Center (NUMC) – 531 beds The A. Holly Patterson Extended Care Facility (AHP) – 589 beds Five community health centers in conjunction with the Long Island FQHC, Inc. NuHealth is Nassau’s safety net provider, providing care to residents living predominantly in the county’s 33 federally designated medically underserved areas.
3. Long Island – Susceptibility to Flooding in Major Storms NUMC AHP LBMC and Nursing Home Long Island is extremely susceptible to flooding from major hurricanes. During the last two major hurricanes (Irene and Sandy), NUMC and AHP sheltered patients from the Long Beach Medical Center and its associated nursing home.
4. Before the Storm Hit… Friday, October 26th: Our Sandy journey began. We spoke with the leadership of the Long Beach Medical Center (LBMC) and agreed that, as with Hurricane Irene, we would partner on evacuating the hospital and its affiliated nursing home (the Komanoff Nursing Home). Saturday, October 27th: Preparation day. The team at LBMC faxed over face sheets with patient information and prepared transfer notes, including medical, pharmacologic, nursing, and other issues related to the hospitalizations. Our team worked on the challenge of accepting 55 acute care and 35 nursing home patients, such as staffing, beds, food, medications, and facility support. The 20 patients from LBMC’s inpatient psychiatric ward required the opening of a previously closed unit at NUMC.
5. Before the Storm Hit… Sunday, October 28th: Transfer day. LBMC staff transported their patients and a triage team (chief medical residents, a hospitalist, psychiatrists, nursing staff) met them near their entrance point. They reviewed patient records, assessed medication regimens, and facilitated the admissions process. Over a period of 6-8 hours, these patients were integrated into our hospital. At the same time, AHP took in 35 residents and, because it was already near capacity, admitted these residents to a redesigned auditorium. And then we awaited the onset of the storm….
6. In the Wake of the Storm…. NuHealth experienced a series of dramatic and unprecedented operational challenges in the wake of Superstorm Sandy. These included: Interrupted Communication: Cellular devices worked haltingly, internet access was unreliable. Increased Census: Within 72 hours of the storm, NUMC’s census rose from 330 (pre LBMC transfer) to a peak of 570 patients. AHP’s census exceeded 620 (its normal operating census is approximately 570 residents). Markedly Different Census: The patient population filling our beds was increasingly frail elderly who lacked support from relatives or home health agencies. Increased ED Utilization: NUMC’s ED was inundated with patients seeking O2 tank refills, dialysis, and prescription replenishment. We also saw a number of cases of carbon monoxide poisoning.
7. In the Wake of the Storm (cont)… Staff home displacement: Numerous employees sustained significant property damage, many losing their homes. Our employees were victims as well as first responders. Staff shortage: NuHealth was not staffed to sustain safe care for a census as large as 570 in its hospital and 620 in its nursing home. Fuel shortage: Though NuHealth had arranged regular shipments of fuel, employees were not able to fill up their vehicles at gas stations, due either to limited supply or excessive lines. No place to which to discharge patients: With south shore nursing homes knocked off line, it was immensely difficult to find safe placement for patients who could be discharged.
8. NuHealth’s Response We kept doing what hospitals do – 7 babies were delivered DURING the height of the storm. We sustained highest HICS level for nearly three weeks. Multiple daily incident command center meetings. Meetings as “standard work”. ICS available as central point of communication. Regular updates from ICS posted on web, made available to media, and disseminated to employees and to Board of Directors. Participation in North Shore – Long Island Jewish Health System emergency response program. Constant communication and coordination with county, state, and federal officials. We created a fuel dispensing and rationing system for employees / partnered with local gas station to make fuel available to hospital and nursing home employees. Approximately 3,000 gallons of gas were distributed to staff, with another 300 gas tickets provided to staff to obtain fuel at local gas station when it opened.
9. NuHealth’s Response Credentialed and deployed approximately 165 medical professionals from LBMC to supplement our staff. Established transportation system for patients to and from emergency shelters. Created car pool communication board to help employees conserve fuel and get to and from work. Deployed family practice residents to emergency shelters to triage patients and, ideally, keep patients away from the hospital. Sent discharged patients home with three day supply of meds to try as best as possible to avoid immediate readmissions. Created capacity wherever possible (re-opened units under renovation, hallway beds, use of atriums, etc.) to house patients at the hospital. Created capacity in the hospital to permit staff on multiple shifts to sleep, shower, and eat. Quickly renovated empty resident housing to make units available to employees who lost their homes (also connected these employees with other social support services, such as the local food rescue organization). 24/7 crisis counseling provided to impacted employees. Conducted a fund raiser through Foundation to support displaced employees.
10. Our Family Medicine Residents at the Emergency Shelter Our Team of family medicine residents were deployed to staff medical services at the Nassau Community College hurricane shelter beginning on Wednesday, October 31, 2012. Our mission was to assist those in need of medications due to chronic medical conditions, but also as best as possible limit the number of patients sent unnecessarily to our hospital.
11. Yet, We Still Needed Assistance…. On the Friday following the storm, my Chief Nursing Officer contacted me to indicate that she could no longer reliably and safely require her staff to report to work. Our census remained at dangerous levels, despite every possible effort to discharge patients. NuHealth contacted Nassau County Emergency Management as well as the New York State Department of Health to request – urgently – clinical staff to supplement our beleagured workforce.
12. DMAT and NPHS to the Rescue DMAT team in our ICS….. A “unique” model…. The federal government deployed an 50 member Disaster Medical Assistance Team (DMAT) as well as a National Public Health Service (NPHS) team. The DMAT was integrated into NUMC’s inpatient and emergency medicine units, creating what we were advised was a unique model of emergency response. The NPHS team provided real-time crisis counseling to our staff.
13. The DMAT Deployment made Our Sustained Response Possible The DMAT Team…. How the Team worked…. To support our response to Superstorm Sandy, the federal government sent 50 health care professionals (physicians, nurses, paramedics, x-ray techs, and pharmacists) from Texas, Ohio, and Kentucky. Though the usual model for DMAT is to work in tents outside of hospitals, the integration of the DMAT clinical professionals into our clinical teams worked flawlessly and elicited extraordinarily positive feedback from our staff and from the DMAT team.
14. The Pressure Subsides…. By mid-November, our hospital census receded to manageable levels, and NuHealth was able safely to transition from its reliance on the supplemental support provided by DMAT and NPHS professionals. It was at this point that NuHealth was also able to ratchet back and wind down its incident command operations.
15. Some Lessons Learned Utilize the management structure you are most comfortable with; an emergency is no time to try something new. Utilize the LEAN concept of “standard work” to run your ICS. Broaden your preparedness plans to: Include responses for frail elderly, patients who need dialysis, and patients without primary care options. Include extended sheltering of employees. Address possible gas shortages.
16. Some Lessons Learned Identify multiple methods to communicate with all shifts (in a post-incident survey, this was identified as our greatest weakness). Work with your local or state Departments of Health to put in place regional strategies to address, in an emergency, patients who need dialysis, frail elderly who cannot access home care, etc. Work with your local or state Departments of Health to develop clinical staff redeployment strategies. Take advantage of emergency preparedness training sponsored by the federal government, such as through the Department of Homeland Security’s Center for Domestic Preparedness.
17. I’m Very Proud of the NuHealth Team…. “I was very impressed with the command execution of the command center team as well as your administrative officers. They get it! You all understand the Incident Command System and you are very effective and intuitive. In my many years of experience, I found it to be very well run! Not only are you trying to mitigate a crisis, but you are primary victims, yet still continue to put patients’ needs ahead of everything. You are to be commended for this! You had your priorities straight. The things you did to care for your people, I have never seen that level of command organization in a hospital.” DMAT TEAM LEADER KEVIN HOBAN FIRE CHIEF MESILLA, NEW MEXICO November 9, 2012