Out of disaster, an opportunity to improve
Out of disaster, an opportunity to improve
Tropical storm creates a chance to boost quality
As the old saying goes, "When life hands you lemons, just make lemonade." That’s precisely what happened at East Houston (TX) Regional Medical Center, where Tropical Storm Allison created an unforeseen disaster. However, it created the opportunity to improve the quality of care for its emergency department (ED) and industrial medicine patients. The storm not only caused hospital staff to take a new look at quality processes, but in some cases, since the hospital had to be closed, it gave them time for training and education that they might otherwise not have had.
Before Allison hit Houston in June 2001, officials at East Houston had every right to feel prepared and protected; after all, their facility was guarded by three-foot-high flood gates. But not only did Allison’s flood waters rise above those gates, they also created water levels of three or four feet within the hospital itself. "We started the evacuation process for our ambulatory patients as soon as we realized the storm was not letting up," recalls Kris Barton, industrial medicine marketing coordinator. "But it hit so fast, so quickly, that some of the patients had to be evacuated in boats."
Improving patient flow
The industrial medicine department at East Houston provides post-accident care for employees throughout the city; all of these patients are processed through the ED. "We had been conducting studies on patient flow through the ED even before Allison hit," notes Barton. "We had been taking a close look at wait times as well."
The studies found the current flow methods being used were not as effective as the staff had thought. The problem was that changing the system was going to cost money, and funds were scarce because East Houston had just remodeled and expanded the ED. "After Alison, however, we had to gut the entire bottom floor of the hospital, from the ceiling down," Barton observes. "Ironically, this gave us the opportunity to improve patient flow through the [emergency room (ER)]."
Previously, patient admission and discharge was handled at the bedside. "This tied up beds, kept people in the ER longer, and kept patients in the waiting room longer," Barton notes. After Allison, the hospital designed a separate area where patients could go for admitting and discharge. This freed up beds and reduced wait time in both areas. "This improves quality of care for our industrial hygiene patients," Barton asserts. "If someone has a cut, for example, you want to get the patient in and treat them as quickly as possible, and release them back to work. The companies want them to return, if they are physically able, and the employees want to come back, too. We’ve had workers who had the tips of their fingers cut off who insisted on getting back to work."
Another recent change at East Houston, although instituted pre-Allison, was a designated bed for industrial medicine. "It’s located in the ER, so when an industrial medicine patient presents himself we have a bed already available," Barton explains. When the ED is extremely busy, they will utilize that bed as well, she notes.
Training increases
Prior to Allison, waiting times for industrial medicine patients were also longer for certain testing, says Barton. "We only had a certain number of staff trained to administer [Department of Transportation] drug testing and breath alcohol tests," she explains. "We had to get people from the outside to do the tests." Since Allison, however, more internal staff have been trained to be breath alcohol technicians. "Now the patients don’t have to wait for someone from the lab to be freed up to administer the tests," she notes. "Also, we are better able to control the quality of the tests." In addition, she says, the shutdown after Allison actually afforded East Houston the opportunity to meet an Aug. 1 deadline for re-certifying and retraining staff. "The hospital paid for everybody to work during that time," says Barton.
East Houston is also working hard to make sure it is even better prepared for the next disaster. "We’re going out into the community and obtaining company protocols — who to contact, what tests need to be done, and so on — so we will be prepared to take care of the patients before they walk in the door — and before the next event even takes place," she concludes.
[For more information, contact: Kris Barton, industrial medicine marketing coordinator, East Houston Regional Medical Center, 13111 E. Freeway, Houston, TX 77015-5820. Telephone: (713) 393-2509.]
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