Take time to put your priorities in order

Determining who needs your care the most

In the wake of a natural disaster such as a tornado or flood, some patients are going to be difficult to reach. Having a reliable database is an essential tool to weathering the storm successfully. With the right information, patient care can be prioritized and assigned to aides who either live closest to the patients or are best able to reach them.

Remember, in an emergency it’s not important which aide pays a visit, but simply that one does. Take the case of Henry Ford Health System Home Health in Detroit, a city that isn’t typically paralyzed by snow, but where it has happened. "In general, it takes a lot of snow to paralyze this town," explains Greg Solecki, vice president of Detroit-based Henry Ford Home Health Care. "The snow thing really doesn’t throw us for a loop. It takes a lot to keep us home."

While members of Solecki’s staff have gone "off-road" to reach patients in need of care, not everyone has access to snowmobiles or four-wheel-drive vehicles. To make sure those who need care the most are receiving it, it’s a good idea to assign patients a treatment status upon admission and keep that list on file and constantly updated. If you’re unsure how to classify some of your patients, ECRI, a nonprofit international health services research agency based in Plymouth Meeting, PA, has printed a criterion level developed by the Daughters of Charity National Health System in St. Louis.

Listed below are suggested priority levels for determining the provision of service:

o Priority one

The life or well-being of the client may be significantly jeopardized if services are not provided that day. Examples include, but are not limited to: complicated wound care, insulin injections, IV medications, or TPN when there is no available capable caregiver or client cannot perform independently; new referrals already discharged home from a facility with acute needs; Home medical equipment clients on ventilators, or oxygen-dependent and needing STAT delivery.

o Priority two

No significant adverse effects for the client are anticipated if services are postponed for one to two days. Examples include, but are not limited to: clients scheduled to receive services that are capable of self-care or have a willing and capable caregiver and could be coached over the phone (if phones are available); phototherapy clients with Tbili level less than or equal to 15 with a documented downward trend; HME clients needing servicing of apnea monitors, phototherapy equipment, internal feeding pumps or oxygen.

o Priority three

No significant adverse effects for the client are anticipated if services are postponed for two or more days. Examples include, but are not limited to: mother-baby visits, cardiopulmonary assessments on established clients with uncomplicated courses; HME clients requiring nonemergency equipment such as bedside commodes, CPM machines, or hospital beds.

o Priority four (skilled shift program only)

No significant adverse effects are anticipated for the client if services are postponed for the duration of the emergency or disaster. Examples may include, but are not limited to: clients receiving respite care or basic pediatric nursing care.


Amy Goldberg-Alberts, Senior Risk Management Analyst, ECRI, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298. Telephone: (610) 825-6000.

Cynthia Runner-Heidt, RN, MSN, Administrator, Lehigh Valley Home Care and Lehigh Valley Hospital Patient Care Services, 2166 S. 12th St., Allentown, PA 18103. Telephone: (610) 402-7300.

Gregory P. Solecki, Vice President, Henry Ford Home Health Care, 1 Ford Place, 4C, Detroit, MI 48202. Telephone: (313) 874-6500.