CMs work overtime in Sandy’s wake
Hospital inundated with evacuated patients
Days before Hurricane Sandy roared through the East Coast, the case management staff at Lutheran Medical Center in Brooklyn was working overtime to discharge patients and free up beds for patients injured in the storm or being evacuated from other hospitals and skilled nursing facilities. The hospital also needed beds for staff who were staying over during the storm and its aftermath.
Case management staff worked overtime on Saturday and Sunday — October 27 and 28 — in anticipation of the storm, which hit the area on Monday night, says Vivian Campagna, MSN, RN-BC, CCM, vice president, case management for the 462-bed academic teaching hospital. “We discharged a significantly larger number of patients to home or to skilled nursing facilities than we do on a typical weekend. On Monday, we focused on patients who could be moved to skilled nursing facilities that were not likely to be flooded so we would have as many beds as possible,” she says.
When the New York area experienced Hurricane Irene in August 2011, Lutheran Medical Center accepted patients evacuated from facilities in low-lying areas before the storm hit. “This time those same places had emergency plans in place and generators and did not feel like they needed to transfer patients and disrupt the flow,” she says. But Sandy hit with an unexpectedly strong intensity and many facilities were flooded and without power and telephone service.
“With a hurricane on the way and a low pressure area making it a perfect storm, we knew it was going to be pretty severe, but I don’t think anybody expected the New York area to take the full brunt of the storm,” Campagna says.
Campagna came to work Monday morning with three days worth of clothing and a blow-up bed. “I knew I could get home, but there was a likelihood that I couldn’t get back on Tuesday. I knew we needed to have leadership at the hospital so we could keep things going,” she says.
Some of the case management staff lived nearby and were able to get back to the hospital. One group got together and hired a car service to bring them in. One social worker spent the night after her shift. “Some people couldn’t get back to the hospital. We had a skeleton staff, and everyone worked extremely hard to take care of the patients,” she says.
The facility received patients evacuated from a number of skilled nursing facilities and one hospital. The skilled nursing facilities transferred appropriate patients to evacuation shelters but evacuated those with medical issues that might need to be addressed to the hospital, where the emergency department staff assessed them to see if they needed an inpatient stay.
“During Irene, we had good communication between facilities and good patient summaries and documentation. With Sandy, the skilled nursing facilities did not plan on evacuating patients, and often they just send the patients in an ambulance to the emergency department without notifying us,” Campagna says.
The hospital received minimal information from the skilled nursing facilities and, in most cases, couldn’t contact the facilities because they were without power and phone service and the buildings were empty.
Some of the patients met inpatient criteria. The hospital admitted them and kept them until they were ready for discharge. Case management scrambled to find placements for patients who did not qualify for an inpatient stay.
“We tried thinking out of the box and finding places for these patients. The skilled nursing facility in our system had some vacancies and also created additional space by putting beds in some recreation rooms. We tried to get some of the patients in other skilled nursing facilities that had not been evacuated,” she says.
When the storm had passed on Tuesday, the case management staff worked to identify as many discharges as possible and free up more beds. The hospital provided transportation if the patients couldn’t get home any other way. If patients couldn’t go home because they had no power or no one to take care of them, the hospital transferred them to skilled nursing facilities that had free beds or evacuation shelters.
A variety of patients came to the emergency department after the storm passed. They included patients injured by the storm, older patients who fell because they had no electricity in the home, and patients on supplemental oxygen who had no electricity.
Patients who didn’t meet medical necessity criteria were evaluated, treated if necessary, and moved to evacuation shelters or skilled nursing facilities. “Case managers and social workers worked really hard to identify whatever alternatives and options there were. We couldn’t relax the criteria for an acute care admission because we needed to keep beds available for patients who needed them. It would have been difficult to say we’d take a patient unless someone sicker came along,” she says.
Two weeks after the storm, a handful of patients evacuated from the skilled nursing facilities were still at the hospital because the skilled nursing facility they came from had not reopened and an alternative place was not available.
“The storm created a chaotic situation, but our staff did a yeoman’s job. Our response to the storm was a well-choreographed dance,” Campagna says.
Source
- Vivian Campagna, MSN, RN-BC, CCM, vice president, case management, Lutheran Medical Center, Brooklyn, NY. email: [email protected].
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