Access staff coped with ED volumes

Staffing shortages and having to pull staff from other areas due to volume surges in the emergency department (ED) were two challenges Annemarie Rappleyea, CPAR, patient access supervisor for the ED at Community Medical Center in Toms River, NJ, faced during Hurricane Sandy.

“The outpatient department and financial counselors were pulled to the ED to assist, in order to replace employees who weren’t able to make it in,” she says.

The ED saw a sudden surge in volume, including individuals unable to get their medications due to pharmacies being closed or who ran out of oxygen due to power shortages, as well as those with storm-related injuries.

Rappleyea staffed the ED’s quick care area with one experienced ED registrar alongside the outpatient and financial counselors who were pulled from other areas. With this system, staff who had never worked in the ED before didn’t have to suddenly adjust to the crowded, chaotic main ED.

It also helped that all of the hospital’s registration areas use the same software. “So it was just a matter of getting them acclimated to the department,” says Rappleyea. “When we pulled the staff to the ED, we assigned them to their own group in one area, with their coworkers. We moved the actual ED staff throughout the department.”

The EDs at Camden, NJ-based Lourdes Health System saw a significant number of homeless individuals who mistakenly thought that shelters were being set up only for people whose housing was damaged by the storm, says Joan Braveman, corporate director, patient access. “There was no public transportation, and when they were found not to be ill, our challenge was to get them back to the shelter,” says Braveman, adding that some registrars volunteered to drive individuals to ease the burden on the ED.

At Robert Wood Johnson University Hospital in New Brunswick, NJ, the storm resulted in a surge of patients presenting to the ED for several days, reports ED registration manager Lazara Richardson. EDs throughout the region were also caring for patients in need of medical shelter, Richardson adds. “Needing medical attention that became unavailable during the storm and its aftermath, these patients came to the hospital for care and assistance,” she says. They included dialysis patients, mechanically-vented patients, and patients on continuous oxygen.

“We also saw many elderly ‘social admits,’ and patients too frail to stay at home without heat or electricity,” says Richardson.

Kathy B. MacGillivray, MHA, director of access management services at Robert Wood Johnson University Hospital, says that when hospital administration opted to cancel elective admissions because of the storm, “we pooled all of our personnel resources to focus on addressing the ED volume. We were able to do this only because we maintain cross-training standards.”

Inpatient registration teams were dispatched to the ED to support the volume surge in that area. “Practices that maintain staff competencies in all registration pathways and area-specific requirements made the re-assignment possible,” MacGillivray explains.