Disaster victim locator poses access challenge

What if you don't have patient's name?

What happens when — in the wake of a disaster — hospital personnel are dealing with an influx of patients, many of whom have not been identified by name? How do access employees help family members who are trying to locate their missing loved ones?

Those questions are at the heart of a challenge presented to Gillian Cappiello, CHAM, senior director for access services and chief privacy officer at Swedish Covenant Hospital in Chicago.

"I was asked by our safety officer to develop a victim locator policy as part of our application for HRSA [Health Resources and Services Administration] funds," Cappiello explains. "The Chicago Department of Public Health requires that the hospital incorporate a process for locating patients in our emergency and disaster management plan."

The passage that specifically addresses that requirement reads: "Locating the whereabouts of a loved one is a normal response and often becomes a consuming activity for survivors. Hospitals and hospital staff can become quickly inundated with telephone calls and onsite presentation of family and friends attempting to find their lost mother, father, sister, brother or friend.

"After 9/11, St. Vincent's Hospital in New York had more than 5,000 loved ones present to the hospital in attempts to locate missing persons," the passage continues. "It is with this understanding that it is in the hospital's and community's best interest to develop a psychosocial disaster plan, which clearly describes the hospital process in victim location activities."

Swedish Covenant has a specific agreement with the American Red Cross regarding the release of patient names and information, which basically calls for releasing only the minimum necessary, Cappiello says. "In a disaster you have to weigh what is in the best interest of the patient, family, and community."

However, she adds, with this project she is not talking about releasing the names of victims. "If we have someone of that name, then that is like [the person is in] the patient directory and we can tell those who are inquiring that the person is here and give the condition in general terms.

"If we don't have anyone with that name but we have John Doe, we can ask for physical description, such as sex, age, height, hair, and eye color, identifying features, and clothing," she says.

One of the solutions Swedish Covenant is pursuing is the development of a web-based resource, similar to the one it uses for physician referrals, Cappiello says.

Instead of entering physician preferences (such as specialty, gender, office location, languages spoken, etc., and looking for a match), she notes, the user would enter what is known about a victim, such as gender, age range, race/ethnicity, item of clothing (i.e., black pants), and whether, for example, the person has a tattoo or body piercing.

Cappiello seeks feedback from her fellow access professionals on any of the issues involved in identifying victims and connecting patients and families during large-volume disaster situations, including answers to the following questions:

  • Do you get a log of patients — perhaps have them sign in — even before triage?
  • Do you gather information, such as eye color, hair color, what the person is wearing or whether there are piercings or tattoos in order to help with identification if the patient is unable to provide his or her name?
  • What other steps might you take if someone is inquiring about a possible victim and you don't have the name? If you think you have someone who matches the description, then what do you do? How do you connect the inquiring person with the individual you think might be a match?
  • Do you ask if the friend or family member wants to see that individual? Do you involve an emergency department physician or nurse, perhaps a chaplain?
  • Do you take photographs to help in the identification process?

Determining patient share

Cappiello also would like feedback regarding methods for accurately calculating, based on payer contract, the patient's share of the hospital bill so that staff are able to quote a fairly precise figure, rather than a huge range.

"Are other [access departments] getting a lot of inquiries from patients who have PPO plans that the facility contracts with?" she asks. "If the patient is coming in for, say, a $2,500 MRI, we know about the deductible, but are [other facilities] using any software to determine, based on the contract with the payer, what the patient share is?"

Complicated, varying terms from different payers make it hard to answer, Cappiello notes, when the patient asks, "What is the rest of my out-of-pocket cost going to be?"

[Editor's note: If you have feedback on this or any other topic of interest to access managers, please contact Editor Lila Moore at (520) 299-8730 or lilamoore1@msn.com. Gillian Cappiello can be reached at GCappiel@schosp.org.]