During Hurricane Katrina, all organizations in the area had “tremendous challenges” with registration, says Stacy Calvaruso, CHAM, system director of patient access for LCMC Health in New Orleans.
“That incident was treated like a war-zone process, that actually flipped the priorities from patient identification and registration and treatment, to clinical triage and categorization, followed by patient identification and registration,” says Calvaruso, who worked for a different organization in the New Orleans area at the time.
The problems lasted for up to 10 days, depending on the location. “We were doing patient care in the parking garage, as we had thousands of patients coming in,” says Calvaruso. During other weather events, the department has had outages for six to eight hours.
“We keep a downtime emergency kit for the registration areas available at all times. Everyone knows where it is,” says Calvaruso. The kits are used by patient access whenever the system is unexpectedly down, whether due to a natural disaster with large numbers of casualties, a cyberattack, or other issues. These items are stored in a waterproof container:
- 50-75 downtime charts;
- 100 armbands for children and adults;
- waterproof permanent markers, so patients or their clothing can be marked for identification purposes if staff run out of downtime charts, or staff can write on posters that serve as bed boards;
- paper and pen;
- two-way radios;
- flashlights and extra batteries;
- blank labels, to be used for patient clinical services;
- digital camera with large secure digital card and extra batteries, used to identify individuals who are dead on arrival during weather-related or other disasters;
- tape and scissors, to attach items for identification purposes to individuals who are dead on arrival;
- downtime chart log.
“We keep the log so that we have a centralized list of which downtime chart number was used, and so our centralized dispatcher can confirm or deny that we have that particular patient,” says Calvaruso.
ACCESS TO BACKUP DATA
Being able to access necessary data if the EMR is unavailable during unscheduled downtime is a necessity for patient access departments.
Phyllis A. Cleary, CHAM, director of patient access and eligibility services at The MetroHealth System in Cleveland, OH, meets regularly with the hospital’s admissions/discharge/transfer information system team to discuss unscheduled downtown strategies.
“We reviewed Epic’s downtime backup method and the reporting functionality to be utilized during scheduled and unscheduled down-time,” says Cleary. Cleary worked with nursing leadership to ensure that reports, which are updated hourly, contained all pertinent information. This information includes patients identified with an isolation factor, diagnosis, attending provider, patient name, medical record number, gender, and date of admission.
“We have over 50 inpatient and 65 ambulatory PCs designated where the Epic reports can be printed during downtime,” says Cleary. “The PCs have generic logons for ease of access.”
MetroHealth System maintains generic medical record numbers and contact serial numbers in the emergency department, labor and delivery, and admitting to use during downtime. Recently, MetroHealth System had unscheduled downtime for about six hours.
“Our advisory alert system automatically sent text and email alert notices to key personnel,” says Cleary. The patient access department took these steps:
- Staff members used their personal phones to alert their respective managers of the situation.
- Scheduled conference calls were used for regular updates by key clinical and operations personnel.
- When the system was brought back up, patients were entered into Epic.
“Any duplicate medical record numbers were merged upon patient discharge,” says Cleary.
- Phyllis A. Cleary, CHAM, Director, Patient Access & Eligibility Services, The MetroHealth System, Cleveland, OH. Phone: (216) 778-4722. Email: firstname.lastname@example.org.