Accreditors warned hospitals of shortcomings before the hurricane

March 18th, 2015

A report http://1.usa.gov/1wo9bcDjust released by HHS’ Office of Inspector General found almost all (89%) of the 172 hospitals hit hard by Hurricane Sandy almost two years ago experienced “critical challenges” such as not enough fuel, not enough beds, as well as failures of their electrical and communication systems. That fact isn’t all that surprising. The disheartening part is that most of these hospitals had been cited in the three years before the hurricane for deficiencies in meeting emergency preparedness and response standards, according to a news report http://hosted.ap.org/dynamic/stories/U/US_SUPERSTORM_HOSPITALS?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2014-09-17-10-04-11from the Associated Press.

Many of the issues cited in the accreditation surveys were the same ones that popped up during the storm. For example, 47 of the hospitals in New York, Connecticut, and New Jersey had been cited for utility problems such as not testing their backup generators correctly or as frequently as required. After the superstorm hit, about half of the hospitals had problems with electricity, and half of those specifically had problems with backup generators, according to AP. Bellevue Hospital Center had to evacuate due to fuel pumps in the basement that flooded. Langone Medical Center was another hospital that lost generator power and had to evacuate. (See our blog `Everyone here is a hero’ – Hospital evacuates patients in middle of `Frankenstorm.’) http://hospitalreport.blogs.reliasmedia.com/2012/11/01/everyone-here-is-a-hero-hospital-evacuates-patients-in-middle-of-frankenstorm/

Other problems, according to AP:

• Some staff hadn’t been properly trained or had no experience in working without power. Nurses had to quickly learn how to count IV drips manually, for example.
• Hospital needs were not included in all of the communities’ emergency planning.
• There were worker shortages. Sometimes physicians and nurses could travel on closed roads, but members of the maintenance and security staffs weren’t allowed to pass through.
• There were patient surges from the 12 hospitals that evacuated some or all patients, plus more patients from closed dialysis centers and methadone treatment centers.
• Some patients just needed minor help, such as working power outlets for their oxygen machines. They could have received this type of assistance at a shelter, but there weren’t enough shelters, and sometimes patients didn’t know about the ones that were open.
• There hasn’t been enough federal funding.

So what works? Review your disaster plans regularly. The hospitals in Sandy’s path have done this, and some have updated policies and procedures, as well as their equipment. For example, Bridgeport Hospital had about eight “stair chairs” for evacuation. Now it has about 30.

What else? Drill. A lot. We heard the same thing after a tornado hit a hospital in Americus, GA, several years ago. Although the hospital had never drilled for an internal disaster, all of the drilling paid off in that staff responded quickly and decisively. The nurse manager and ER clinical coordinator, who had the role of evacuator, said, “They gave us a game plan on how to evacuate internally, because they were about handling massive amounts of patients." The vice president of nursing agreed. "They might have not done it just by the book, but they knew someone had to track every patient as they were transferred, and they knew all hands had to be on deck to evacuate. We practice and we practice all the time, I'm telling you. When you get so panicked and in the midst of chaos, it takes that practice, because it becomes what you do instinctively." (For more on this topic, see our blog “Is your hospital prepared for disaster?”) http://hospitalreport.blogs.reliasmedia.com/2013/05/23/is-your-hospital-prepared-for-disaster/