Patient Safety Quarterly
Beat Mother Nature to the punch with good emergency plan
Don’t get caught without one
When the waters of the Ohio River started rising in Louisville, KY, in March 1997, Janet Connell, CMPE, practice administrator of Nephrology Associates of Kentuckiana knew 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 took 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 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 fortunate. 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 that 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.
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:
• nurse practitioner;
• several nurses;
• medical assistant;
• medical records employee;
• billing representative;
• social worker;
• the assistant to the CEO.
"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 completed, 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 patient evacuation. 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.
Once you have developed a draft plan, don’t wait for a real emergency; test it regularly, Connell emphasizes. 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 recommends full participation. Don’t let staff get away with staying in the building and continuing to work, she says. She also schedules biannual drills herself, but 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 instructs staff to 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 primarily is a test of a phone tree system, she explains. The next day, when everyone is talking about the drill, there are usually people who were unaware it happened. "We try to figure out where the breakdown was and why they didn’t get a message," Campbell says.
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 smooth, and everyone completed his or her tasks, she says.
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