Saint Vincents had a plan and used it when faced with New York’s tragedy
Saint Vincents had a plan and used it when faced with New York’s tragedy
HIM department was not prepared for volume
(Editor’s note: This is the second part of an occasional series about disaster planning in the wake of Sept. 11. Articles in the January 2002 issue of Hospital Payment & Information Management focused on what HIM departments can do to fully prepare for terrorism-related disasters.)
St. Vincent Catholic Medical Centers - Saint Vincents Manhattan in New York City became one of the best-known hospitals in the country after Sept. 11. The hospital handled hundreds of victims of the disaster and fielded inquiries by thousands of family members, media, insurers, and others.
From the HIM department’s perspective, the disaster was handled by the book. The only major problem was not enough disaster records for all of the patients handled Sept. 11-13, says Dianne Chappelle, MPA, RHIA, director of health information management.
"We had 250 disaster records and we needed over 600," Chappelle recalls.
The disaster records were recreated in the event a disaster required an entirely manual system, and it involved a different registration system.
"Part of our protocol calls for HIM staff to track patients, register, and know patients’ whereabouts," Chappelle says. "And that puts some stress on our department because disasters are expected to go a certain length of time."
The department’s disaster plan was geared toward a disaster with a short duration, and no one anticipated a disaster that would last three days, Chappelle adds.
On the other hand, the disaster’s timing was optimal.
"The best time to have a disaster is at 9 a.m. because you’re fully staffed and you have other areas fully staffed too," Chappelle explains. "So our entire department did not have to be mobilized, because other departments came to assist us."
Ambulatory care and clerical staff helped the HIM staff with emergency department intakes.
Another problem concerned the way patients were routed through the hospital. In the department’s disaster plan, it was expected that patients would enter the hospital through the emergency department. Instead, patients arrived through every entrance, Chappelle says.
"That caused confusion, especially for those of us who were trying to keep track of the whereabouts of patients," Chappelle says. "As we’re going through the disaster we can’t just say, Don’t bring them here or there.’"
Although many of the patients arrived without identification and in a state of shock, there were very few patients who were not immediately identified, Chappelle says.
However, the disaster plan called for attaching identification bands to each patient, and this proved to be a problem for patients who were burned or had other kinds of injuries on their arms and legs.
"So we’re going to look to where else we could possibly put ID bands and how else to tag patients," Chappelle says.
The hospital also was expected to track emergency service workers, including police officers, fire fighters, and ambulance crews, and that proved to be difficult.
"The need to know more quickly and identify them more quickly was an issue," Chappelle says. "People wanted to know who was in the hospital and who wasn’t, and they needed the information right then."
The HIM department created a log to track emergency service workers, she adds.
Other issues the department encountered involved a duplication of records, patients listed more than once, misspellings, and demographic information gaps.
"We were making modifications as we went along, but we couldn’t sit down to address the problem on that day," Chappelle says.
Many patients were hysterical upon admittance and were unable to provide the necessary information. Taking this problem into account, the department has revised the disaster plan to call for obtaining demographic and some other pertinent information at discharge, instead of when patients are admitted, Chappelle says.
"The registration process will continue throughout the disaster mode, resuming later when patients are much calmer," Chappelle says.
Since the week of the disaster, there have been many requests from the city’s health departments that want to know how patients were treated, what services were provided, and the outcomes. The health department is looking at the types of injuries and whether anything biological, nuclear, or chemical was involved, and this has required HIM staff to retrieve medical records and make them available to public health officials, Chappelle says.
"Another major impact is how a disaster impacts your staff," Chappelle says. "People were very upset and distraught, and this is a city where everyone travels by mass transit, so people are worried about taking mass transit and having it available during off times."
Because some of the city’s subway lines were shut down, some staff had trouble getting in to work in the first days after the disaster. This meant rescheduling and finding staff to fill in when those who lived in outer boroughs were unable to make it to work.
In the weeks afterward, the hospital offered employees counseling services, stress management, acupuncture sessions, and handouts about what to expect and what’s normal to experience after a disaster.
"At first, people come in and go through the motions and productivity is down, but it eventually gets back up," Chappelle says. "It wasn’t such a problem that we couldn’t do our billing or coding or releasing information, but there was a different mood in the city."
In retrospect, the HIM department did a good job of handling the disaster, Chappelle says. "Thank goodness we had a disaster plan that worked very well."
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