Outmoded tools get used again during critical time
When the registration system at the Medical University of South Carolina (MUSC) went down, the bed management area suddenly became the facility’s focal point, says Maureen McDaniel, manager of bed management. "Because we’re centrally located and have a huge [bed] board in front of us, we became the information center for the whole hospital."
Her department was inundated with telephone calls from people looking for patients, McDaniel adds. "We had to find ingenious ways to let people know where patients were, who was in-house, whether they had been admitted. The communications center [staff] didn’t have any idea where anybody was and would transfer the calls to us. A family member would say, I dropped her off this morning — I know she’s there somewhere.’ There was anxiety at not being able to find their family member."
Policies will deal with problems
As the hospital continues to recover from the April 1999 system failure, her department is putting different policies in place to better deal with any future problems, McDaniel says. One plan is to have the registration and billing software transfer bed control information to the database of the Windows 95 system that is used for word processing and e-mail.
"Around midnight or after, the computer would dump the most current patient list into this database," adds Susan Pletcher, director of access services. "So if we lost the registration system again, we would have the most current information on where patients were. Multiple people have access to it."
It would be the responsibility of the bed management staff to update that list via the Windows system, McDaniel says.
One procedure already in place, she notes, calls for her staff to fax a "patient movement log" to key departments every two hours during a computer failure. The log, which includes all admissions, transfers, and discharges, is sent to lab, pharmacy, and food service, McDaniel adds. "This cuts down on things like medication being sent to a [nursing unit] after a patient has been discharged."
Another result of the registration system being down was that patient logs, outmoded since the advent of computers, came back into use, Pletcher says. Nurses on the care units began to manually record the patients’ names, the physicians’ names, and times and dates of arrival.
Not having such information is "not a big deal when the system is down for two hours or 24 hours, but overwhelming when it’s three weeks," she notes.
The institution is still trying to catch up on billing in the wake of the system failure, Pletcher says. "Once things got going again, patient accounting [staff] met with different carriers to expedite the transfer of money to make sure we met our obligations."
Most of the companies have offices in Colum bia, the state capital, not in Charleston, she notes, so the MUSC patient accounting representatives drove there to review the accounts in person. For the most part, Pletcher adds, "the insurance carriers and their intermediaries were wonderful and really understood our problem."
A few had concerns about the hospital not obtaining preauthorizations, because utilization review personnel didn’t know the patients were there, she says. "We were told that if they did reject anything for that reason, to send it through again on appeal."
As with any disaster, Pletcher says, "the whole hospital came together, and people worked hard. It certainly could have been worse." The incident cost quite a bit in overtime once it came time to transfer all the paper files into the computer system, she notes. During the actual emergency, however, "some of it was just reassigning people. Coders, for example, didn’t have a lot to do."
The good news was that "patients probably didn’t notice much difference," Williams says. "The interview process didn’t change much." And Pletcher says that although it was "difficult to find out if patients had been transferred or exactly where they were, actual bedside care was not compromised."
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