Four of the six registrars at Redding, CA-based Shasta Regional Medical Center who were evacuated due to the devastating ongoing Carr Fire recently reported for their shift as usual. Their dedication serves as an example of how patient access employees can unite to help each other and serve the surrounding community during a disaster.

“Staff understood the seriousness of the situation. They knew we needed to step up and help our community,” says Kim Rice, MHA, director of patient access and communication at Shasta Regional.

Employees offered to cover the shifts of two employees who were unable to report for work. “I had many staff work overtime and take on additional shifts as necessary,” Rice reports.

About 25% of patient access employees at Redding, CA-based Dignity Health were directly affected by the fire; more than a dozen were evacuated. One registrar lost his home. “So many of the team went above and beyond,” says Daniel Vang, CHAM, director of patient registration at Dignity, noting registrars offered to cover for colleagues who were evacuated. “Many of my staff were back at work without knowing if they still had a home.” Shasta Regional’s patient access department planned to increase staffing for at least five days out. “We figured we should be ahead of the situation, and change things around as we obtain more information,” Rice notes. Staffers took the following steps:

Elective procedures were cancelled. Outpatient and OR schedulers notified physician offices and patients of the situation. “The staff reached out to explain that due to the fire, our resources have been pulled to help the ER with additional assistance,” Rice says. The office staff understood. They also were dealing with numerous physicians losing homes in the fire and closing their offices.

“Once we were in the clear to reschedule, we got these patients right back in,” Rice adds.

Registrars tracked all patients who came to the ED with fire-related symptoms. Staff used a manual process, placing a data sheet into a folder for each patient. “This was a quick and easy way to know how many patients came through to the ER related to the fire,” Rice explains. Later, patient access compared this information to data the clinical team collected. The information was used for internal tracking and was provided to the local public health department for their use.

As soon as the fire was no longer a threat, staff stopped collecting the patient data sheets. In retrospect, Rice wishes she had clarified that they needed to continue until further notice. “First responders and others continued to come in for fire-related diagnoses such as smoke inhalation and difficulty breathing,” she says.

The department prepared to shelter in place depending on patient volume. “I communicated with the patient access team that we could potentially be staying onsite for some time without leaving,” Rice says. Although it didn’t turn out to be necessary, staff were open to this possibility, understanding the severity of the situation.

Additional staff were needed to cover volume surges in the ED. The main admitting department was closed. This allowed cross-trained registrars to assist in the ED. The ED admitting staff took on additional shifts. “The hospital wasn’t sure how many patients would be arriving,” Rice says. “Patient access needed to be prepared.”

Weather conditions increased the intensity of the fire, destroying more than 1,000 homes. At this point, the hospital saw a decrease in patients, which was attributed to widespread evacuations that were underway. Several days later, ED volumes surged, with new waves of patients and first responders alike arriving for assistance.

“Per-diem staff who are cross-trained in both ER admitting and the PBX operator assisted with additional coverage to handle incoming phone calls from media,” Rice says.

Cross-training was a huge help. Staff members from the main registration area covered the ED, and per diems covered both the ED and PBX operator areas. “About two-thirds of the staff are cross-trained,” Rice says. “Having the flexibility to float between these two areas is essential.”

Extra staff were brought in for all shifts in the ED, just in case volume surged. “We did not know what type of census we were going to encounter, but we wanted to be prepared,” says Amber Fletcher, patient access supervisor in Shasta’s ED.

Once patient flow got back on track, the ED returned to its regular shifts. “We knew our team had their own families to worry about,” Fletcher says. “We wanted to be sure that we were being accommodating but also fit the need of our patients.”

Many registrars reported to work despite their own evacuations and not knowing if their homes still stood. “If it wasn’t for the dedication of all the team, it wouldn’t have gone as smoothly as it did,” Fletcher says.