Patient Safety Quarterly - Communicating can require creativity in emergency
Patient Safety Quarterly - Communicating can require creativity in emergency
Computer system, other normal methods may be out
What would you do if your hospital lost all power, all telephone service, and began filling up with smoke? That’s exactly what happened to Betty Wisgirda, CHAM, when she was the director of registration at Good Samaritan Medical Center in Brockton, MA. She was called in at 7:30 one evening a few years ago to help con-trol the crisis. Wisgirda now serves as director of patient registration at South Shore Hospital in South Weymouth, MA.
Good Samaritan, which had just merged with another local hospital, was in the midst of building renovations when some wiring caught fire during the installation of a sprinkler system. Every wire in the building was destroyed.
When firefighters arrived, they gave orders to evacuate the building immediately. "The building has five floors, and we had patients everywhere," recalls Wisgirda, who received a call about the fire from a member of her staff just before power was lost. At that point, there were still two hospital campuses, with a small number of patients at each facility, she explains. Although the census was low at the Cushing campus, where the fire occurred, the 114 patients were spread throughout the building, Wisgirda says.
"One lady had just had major surgery and was on a ventilator," she recalls. "She was carried down three flights of stairs and had to be manually aerated. We were very fortunate that she was the only patient on a ventilator. Having a low census at that time was a boon."
Cellular phones became a key part of containing the disaster, Wisgirda says. "We called people in using a phone tree — I call you and you call someone else — and anybody who had a police scanner knew there had been a fire at the hospital, so a lot of people who worked here came in [after hearing the news] that way."
From the perspective of the admitting department, the No. 1 lesson learned from the fire is that a manual patient census is a necessity, Wisgirda emphasizes. "If you can’t access the computer — and we couldn’t access it for weeks [after the fire] — there has to be a manual system." Fortunately, she says, her department was still using a manual bed board, despite the prevailing view of computer vendors that it’s not necessary to keep such records.
"We had a lot of the information — name, age, doctor, and insurance — and I was very happy that I had that," Wisgirda recalls. "New computer systems say you don’t need to keep such things in admitting, which is well and good if you can guarantee that the system won’t go down."
Hospital disaster plan put into action
The nursing supervisor on duty when the fire occurred took charge of clinical issues, and the vice president on call that evening, who was in charge of marketing and public relations, agreed to deal with the news media. The hospital’s disaster plan designated the lobby as the command center, but because everyone had to be evacuated from the building, the center of operations became a group of chairs in the parking lot. "If we had to do it again, we would have something like a flag to designate that this grouping of chairs was the command center," Wisgirda says. "When people came out into the parking lot, they spent a lot of time looking for who was in charge."
Using a telephone in the medical office building behind Good Samaritan Medical Center, Wisgirda took charge of calling other hospitals to check on bed availability. To get patients out of the parking lot, physicians who had space in that building opened their offices to provide temporary shelter.
Two patients were sent home, and 85 went to the campus of the hospital’s merger partner, where space was found for them in offices, corridors, and the rehab therapy department. About 14 patients went to other hospitals, she says.
One of the priorities during the process was to keep a patient with his or her attending physician if at all possible, Wisgirda points out. Keeping patients and medical records together was another challenge, she says, one that kept staff busy throughout the night.
Patients exit building in orderly fashion
Admitting staff were charged with making sure everyone was out of the building, which they did by checking off names on a list as patients exited. One employee remembered there was a body in the morgue that had to be released by the medical examiner, so there was time to call and get permission for its removal before the building was declared completely off limits.
Admitting employees called patients scheduled for surgery the next day to tell them not to come in, a process that went relatively smoothly, Wisgirda says.
Asked how helpful the medical center’s disaster plan was, she notes that common sense really became the order of the day. "If we went back and looked at the disaster plan, we’d see that we hit the high points, but maybe we didn’t do everything in the order we would have liked," she says.
To celebrate the successful handling of the disaster and the fact that no lives were lost as a result, Good Samaritan prepared a video that includes local news footage and interviews with those involved.
The depiction of the ordeal and the facility’s response was impressive enough that officials at the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, asked for a copy of the videotape, she notes.
"They were very pleased with how we handled things," she says.
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