Beating Mother Nature to the punch
Don’t get caught without a disaster plan
When the waters of the Ohio River started rising in Louisville, KY, in March, Janet Connell, CMPE, practice administrator of Nephrology Associates of Kentuckiana knew that there was a potential problem in the office. "We had had water coming through the sewers into the basement in the past from heavy rain," she says. "We weren’t worried about floating away down the river, but it can be a real mess."
Connell and her office staff had taken precautions, learning from past mistakes that boxes shouldn’t be kept on the floor. While she avoided part of the mess, however, Connell forgot one thing: The telephone connections were on the floor. "We lost our phones," she recalls.
It could have been much worse. Connell developed a plan four years ago when she joined Nephrology Associates. "I came from a practice that had a fire during the day when we were seeing patients," she says. While her old practice was prepared, the one next door was not and left patients in examination rooms during the evacuation procedure. "I knew the importance of having a plan and made sure that the staff did, too."
Roseann Gilchrist, practice administrator at Orthopedic Consultants Medical Group in Encino, CA, also benefited from good disaster planning. A year before the Jan. 17, 1994 earthquake in Northridge, her practice put together a safety committee in order to prepare a disaster plan. Although the practice is in a 12-story building constructed in 1980 according to strict earthquake guidelines, Gilchrist had no idea how it would fare until the quake hit.
Gilchrist’s practice was lucky. Aside from the inconvenience of disruption in phone service, which the practice handled by forwarding the phones to a physician’s home telephone, nothing was severely damaged at the office. Within 48 hours of the quake, the practice reopened, rescheduling patients who missed their previous appointments.
But there were valuable lessons. Now, there are dedicated phone lines that are not part of the office switchboard which will allow both patients and staff to call in for information on the operational status of the facility. A message can be left on the lines or call forwarding implemented from an off-site location.
Put together a good team
A disaster plan is only as good as its team, according to Sheila Campbell, financial counselor at Cardiology Consultants in Pensacola, FL. When she started working on a disaster plan in 1995, she involved staff from every department and from each of the three Florida offices. Included on her team were the following people:
• a nurse practitioner;
• nurses;
• a medical assistant;
• an employee from medical records;
• a billing representative;
• a social worker;
• the assistant to the chief executive officer;
• Campbell.
"You have to have people on your committee from each part of the practice," Campbell advises. "No one person can think of everything for every function in your office."
As team leader, she wanted each member to research a specific area for example, communications needs during an emergency. Once complete, several meetings were held to discuss and revise the plan. The final version was then sent to the policy and procedure committee for discussion and on to the CEO for approval.
Gilchrist’s safety committee also used people from each area of the practice the medical staff, physical therapy, administration, and nursing. Each team member assessed his or her department’s needs, responsibilities, and concerns during various emergency situations, she says. For example, the employee working in the back office at Gilchrist’s office is responsible for evacuating patients. Physical therapy, which has some whirlpool facilities, has to turn off the water. The front office staff are responsible for the computers and other business equipment.
Test your plan
Once you have developed a draft plan, don’t wait for a real emergency, says Connell. Test it regularly. She holds regular (unannounced) monthly drills with staff including physicians. They always happen while patients are being seen, however.
While they don’t have to leave the building, everyone is required to sign out at the door. The next day, the performance is discussed.
Most big office buildings have regular fire drills, and Gilchrist says you should participate in those fully. Don’t let staff get away with staying in the building and continuing to work, she says. Gilchrist also schedules biannual drills herself, but she warns doctors and patients ahead of time and allows patients to reschedule appointments if they want. After the drill, staff who don’t perform as they should are written up, she says. Even physicians have had notes put in their files about poor disaster drill performances.
By discussing performance after a drill, you can make sure that the preparedness plan is a "living" document and not something filed away in a desk drawer. Campbell puts her plan in red folders and makes staff take them home. Prior to a drill, they are told one is coming up but not exactly when it will occur; she suggests that people go over their plans.
The drills at Cardiology Consultants are primarily a test of a phone tree system, she explains. (For more on communications, see related story on disaster plans, p. 63.) The next day, when everyone is talking about the drill, there are usually people who didn’t know it occurred. "We try to figure out where the breakdown was and why they didn’t get a message," says Campbell.
You can also learn from actual disaster experiences. For example, Hurricane Erin hit in August 1995, just after Campbell finished her plan. "We didn’t do very well. Some people didn’t get their phone calls," she recalls. But when Opal struck just weeks later, the plan worked much better. The communications went smoothly, and everyone completed his or her tasks, she says.
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