Here are some of the challenges patient access faced on the night of the 2012 mass shooting inside an Aurora, CO, movie theater:
• Patients arrived who were not part of the shooting but needed emergency treatment.
“Trying to separate the different groups was a challenge,” says Paige Patterson, RN, BSN, house supervisor at University of Colorado Health.
Some patients from the shooting were ambulatory and arrived through the ambulance bay. “These patients self-triaged and went to the waiting room to wait their turn,” says Patterson. “Patient registration was able to register them in the waiting room, alleviating congestion in the ED trauma area.”
Because some patients were accompanied by someone or were alert enough to provide names, staff were able register them using their real names instead of coded “disaster names” such as Disaster 123. “This helped track the patients for the tri-county command center,” she says. “It is difficult to notify families when the actual name is not used.”
Disaster registration packets were available for staff to use that contained quick lab check-off sheets, disaster patient order sets, and registration bands. “Once the patients were registered in the ED, we controlled patient flow through TeleTracking software” manufactured by Pittsburgh, PA-based TeleTracking Technologies, says Patterson. All patients whose names were unknown were labeled as “Disaster.” Labeling patients as “Disaster” allowed patient access staff to monitor their status during their entire hospital stay. “It designated them as a victim of the disaster, differentiating these patients from the ones admitted during the same time,” explains Patterson. This system allowed media relations staff to give an update to the media as to the number of patients still admitted and their clinical status.
Patient access created a list of all patients, demographics, diagnoses, and assigned physician teams for the hospital and regional command center.
The hospital now is regularly holding virtual mass casualty exercises in addition to full-scale exercises to test how well registrars enter disaster medical record numbers. “How well the medical record numbers follow patients through the hospital is another concern,” Patterson says.
• A flood of people called looking for family and friends.
By 5:30 a.m., the hospital established a dedicated phone line for the community to call. “We activated an old number just for this. We pulled staff from registration, operators, and volunteers to man the phone lines,” says Paterson. The hospital’s media team distributed the phone number to news stations.
Registrars manning the call line were given minimal instructions: to confirm who was calling and why. “They were able to verify if the patient was admitted,” says Patterson.
• Registration staff members were in need of counseling and debriefing, just as the staff members in the clinical areas were.
At first, the registration staff members were unaware of the facts of the shooting. “As they were registering patients, they were hearing about the shooting,” says Patterson. “They had to keep their own reactions in check.”
Registrars are accustomed to having a gunshot victim in the trauma room and receiving information from the ambulance team. “Without an ambulance team, they were gathering information form the patients who were lined up on gurneys in the hallways,” says Patterson.
The chaos and traumatic injuries took an emotional toll on the registrars, who later watched news coverage of the shooting. “Staff had to reconcile their role with the whole of the event, how the event was more than they realized at the time. Some questioned what more could they have done,” says Patterson.
For several weeks, the hospital’s psychiatric department and chaplains conducted grief and debriefing sessions for staff members, including patient access members. “Having attended a counseling session or two, it was incredibly healing to hear the stories of our peers attending to the needs of our patients,” says Patterson. (See related story in this issue about how the hospital handled intense media attention after the shooting.)