Hospital hit by tornado shares lessons learned

Peer review files may have been destroyed

Disaster preparedness has been a priority for most hospitals for years, including readiness for the possibility of internal disasters such as hurricanes and terrorism. Sumter Regional Hospital recently was put to the test when their hospital was hit by a tornado which struck Americus, GA, after 9 p.m. March 1.

There were few serious injuries among patients, visitors, or staff. However, one side of the hospital building collapsed, part of the roof was lost, many windows were blown out, and there was flooding. Seventy-five cars in the parking lot toppled on each other.

"I was notified by a family member who also works at the hospital that the hospital had been hit by a tornado," says Angel Lamb, director of the medical staff department. "Cell phone reception was very poor that night, so it took a little over an hour for me to find out."

After all the patients had been brought down from the floors and were being relocated to other surrounding hospitals, quality professionals began trying to retrieve their records. Lamb and other quality staff were able to enter the building on the first day after the disaster, escorted by construction workers. They wore hard hats and boots for protection, and managed to haul out cartfuls of files. After the second day, however, they were no longer allowed inside because mold and mildew presented an infection control risk.

"There was a lot of water in the hallway outside our department, but we were relieved to find that the water had not reached our filing cabinets that were located on the backside of our office," says Lamb.

Staff from several departments helped move the credentialing records from the filing cabinets to another area of the hospital, put the records in paper boxes, and wrapped them in biohazard bags to protect them from moisture. "We were able to retrieve all of our active staff files intact and move them to safer ground," says Lamb.

However, it's possible that all of the organization's archived files were completely destroyed. At press time, technicians were working to retrieve databases from the hospital's servers, which suffered water damage. A company is working to retrieve paper medical records to see if those can be salvaged.

"We kept an Excel spreadsheet of everything that had been sent with the doctors' names, specialties, and the dates that they had been affiliated with us. If that database is retrievable we will have that to pull from," says Lamb. "Otherwise, we will have no way to verify previous affiliations."

For credentialing files, only the past two reappointments are kept in the current files, with the older data purged into a separate file. "The current files are what we were able to retrieve, but the purged active staff files are still in the hospital," says Lamb.

The practitioners who are no longer on staff have been archived. "Those archived files for the past five years are still in the hospital and we do not know the condition of those files at this time," says Lamb. "Anything past five years is kept in another building, which was blown away, so those were destroyed."

If the database can be salvaged, dates of privileges will be able to be verified, but otherwise, the hospital will be unable to verify these, says Lamb. "I guess we will just have a letter in the file that states our records were destroyed by a tornado," she says. "If hospitals have closed and there is no way to get verification from that hospital, usually if you can document the situation in the credentialing file, The Joint Commission will accept that." Quality professionals worked closely with surrounding hospitals to get their medical staff members set up with temporary privileges there, adds Lamb.

Diane Mixon, RN, MSN, CMSRN, Sumter's director of quality and peer review, has one practical tip for quality professionals. "Metal cabinets may not be the prettiest things, but they were the only ones that kept files in fairly good shape," she says. "We got all of the peer review files out and they weren't damaged, but the files in open or wooden cabinets absorbed moisture."

Mixon says that she is hopeful that the server can be salvaged, meaning that the historical data will be able to be retrieved as well. "Anything you can back up and store on a server, you need to do that in a timely manner," she recommends. "There were some files I was working on that may be lost."

As for The Joint Commission's core measure requirements, the Georgia Medical Care Foundation has put in a request to the Centers for Medicare & Medicaid Services for the hospital to be given a reprieve from submitting data due March 15 and for the three following quarters.

"They are trying to intervene on our behalf, because we don't even know if we will have actual files from which to abstract data for a while," says Mixon. Although the hospital began implementing electronic medical records recently, records at present remain only partially electronic. A lot of core measure data, such as for pneumonia and the surgical care improvement project, continue to involve paper records such as ED records and anesthesia records during surgery. "Also, we are not fully operational and currently are only admitting patients for observation," she says. "Quality measure data are based on inpatient data, so it may be a while before we have records to abstract."

The hospital was last surveyed by The Joint Commission in 2005 and expects that during their next survey, the disaster will be a major focus. "I'm sure that the surveyors will be very interested in how we handled this, how our disaster plan worked, and what we have done to better preserve patient safety," says Mixon.