Six ways hospitals can prepare for a catastrophe

  | September 8, 2017

As Hurricane Harvey approached Texas, Rob Turner and Lucky Chopra avoided media reports. Instead, they studied data from NOAA, surf cams and weather buoys — and the bayou down the hill from their acute care hospital in east Houston.

Turner, the CEO of Advanced Diagnostics Hospital and Clinic System, and Chopra, the CEO of Advanced Diagnostics, its parent corporation, had to make a critical decision: Whether to close their 8-bed hospital with an active ER, delaying patient care until after the storm or, says Turner, keep their doors open to “manage what comes."

They decided the facility, perched on a hill, could withstand the predicted winds and flooding — and that, with a few adjustments, they could stay open and care for patients for the duration of the storm.

“Nothing, however, could have prepared us for the amount of rain that came," says Turner. “The most reliable sources predicted 27 inches of rain falling. We got 52."

Despite highways under 10 feet or more of water and the nearby tertiary care hospital flooded and closed, Advanced Diagnostics performed surgeries as scheduled and cared for admitted patients from Friday, August 25th, the day Harvey made landfall, through the following Wednesday.

Now, as Hurricane Irma and other storms approach Florida and other states, Turner and Chopra offer other healthcare organizations and providers these lessons from their experience.

1. Decide as early as possible whether to shelter in place or evacuate

If located in a mandatory evacuation area, Chopra and Turner say, shut down operations and move quickly to a safe area. If it is possible to shelter in place, review the capacity of the facility to endure wind and rain, the topography of the immediate area, and the relative distance from the center of the storm.

“With the nearest bayou downhill from us, we decided flooding wouldn't be an issue for us," says Turner. "If we had been in Corpus Christi, instead of 250 miles from the direction of the storm, our decision-making would have been a lot different."

2. Prepare and review your disaster preparedness plan

Check power sources, back-up generators, and communications channels for phone, internet and television. Confirm that the appropriate amount of food and water is available for patients and staff for three to five days.

“If you come to the decision to stick it out, then look at your plan," says Turner. "Whether you're running a tiny hospital in rural Kansas or a large metropolitan hospital, your checklist is the same: power, communications, food and water."

3. Pick a “ride-out team"

A “ride-out team" is a group of employees who commit to stay for the duration of the storm. Advanced Diagnostics established two teams, each with staff and management —including their chief nursing officer and Turner — committed to staying 24/7 at the hospital.

Turner advises that “if you're on the ride-out team, bring several changes of clothes, your favorite snacks, your phone charger – make sure you will have the things you will need to ride this storm out."

4. Make sure you can access your electronic records

Turner and Chopra note that with their hospital's cloud-based EHR, ride-out teams had full access to patient records and data without risk of loss or damage.

“With our system, we didn't worry about water getting in our servers or about power surges. We had full functionality during the storm. We never lost power, we never lost data. For the most part, we were fully functional and the system weathered the storm with us. I can't imagine a safer way to manage your electronic records."

5. Maintain the schedule for essential surgeries until the storm arrives, then pause until the worst is over

Because the hurricane was projected to arrive Friday night, the Advanced Diagnostics team performed scheduled surgeries until the end of that day, and admitted those patients, if needed, for the duration.

“We felt comfortable that we could get through surgeries that day and not have anything actively going on during the storm," says Turner. "We did admit and take care of those patients instead of evacuating them as a lot of the hospitals around us did. By Monday, it was clear that staff couldn't make it in due to the flooding, so we cancelled cases for Monday through Wednesday. By Thursday, we were back to business as usual."

6. Expect other providers to request to share capacity until their facilities are operational again

Turner says doctors from other practices started calling him on Monday, asking to schedule surgeries in the Advanced Diagnostics OR. "We did some of those surgeries last week and are booking up for this week as well," he says.

Advanced Diagnostics continues to collaborate with surgeons throughout the city, opening its OR and staff to their use. Payers have joined the collaboration, very quickly credentialing Advance Diagnostics, still a newcomer in Houston, in order to maintain continuity of care for patients until other hospitals are back to full capacity — which may take four to six months.

And, with a 20-bed expansion for its east Houston campus already planned, Advanced Diagnostics is now considering doubling the size of that expansion to meet the demand.

"By no means are we celebrating what happened to [other hospitals]; it's devastating and almost more than we can bear ourselves as a smaller hospital," Turner says. "But we're doing all we can to meet the needs of physicians in our local community."

With Hurricane Harvey behind them — and months of recovery still ahead — Turner has many reasons to be grateful for the decision to keep to "business as usual."

“One of our doctor's mother was scheduled for surgery that Friday, due to be discharged on Sunday morning," he recalls. Her home wound up flooding. Her son, the doctor, went out into the weather and was stuck in his vehicle for three days.

"If we had canceled her surgery and she had stayed at home for the weekend, she would have been in serious danger. But she was secure with us throughout the storm. We stayed in touch with her son by text the whole time, saying, 'Don't worry about mom, she's safe with us.'"

Gale Pryor is associate editor of athenaInsight.

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Very nice article! Thank you! I am a new comer to cloud based records. for nearly 40 years I have been hoarding them away. Sort of sticking them under my bed (not really, but still in safes and stuff) . Items one to three above basically say, are Y'all gonna fish or cut bait? ITEM 4 IS CRITICAL! If it is in your safe or off site storage-- you are still dead in the water, that, is said with weeping not black humor! I am a an independent doc in rural Arkansas and will never be on anyone's payroll by the way.
Name: 
THOMAS E B JONES
Email: 
tebjmd@gmail.com
Having been through 7 days without power, water, and only connectivity through cell service that was severely limited after the NW version of a hurricane, and studied many disasters, I would also mention you need a plan to deal with care on paper, have lots of batteries, water, pens/paper and most importantly have a dedicated care team who will be there despite downed power lines, and no ground transport in or out of your area for days. When I went down to the clinic after a major storm to check on architectural integrity there were three patients waiting for me to show up who asked "you're going to be open today, right?" Well, I took care of them with a flashlight and clipboard, and we were open for business without power the next day three days before the hospital reopened and power was restored. With no help from our cloud based EMR.
Name: 
Robert D Peterson MD
Email: 
rpeterson@suddenlinkmail.com

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Six ways hospitals can prepare for a catastrophe