Katrina-born tracking forms aid Rita response
Database tracks 2,500 patients
Necessity, they say, is the mother of invention, and it can’t get much more necessary than trying to track several thousand patients who’ve suddenly been transferred to your city. That’s precisely the challenge that faced the city of Houston in the wake of Hurricane Katrina.
The invention of the trauma professionals who had to face this challenge was a patient tracking form developed "on the fly" and later formalized and modified prior to the arrival of Hurricane Rita.
"If you have been displaced from your home state, your family is going to be looking for you," says Lori Upton, RN, assistant director for emergency services at Texas Children’s Hospital and current chair of the area’s regional bioterrorism task force. In addition, she notes, it was critical to track patients’ movements from one facility to another and to share such information with organizations such as the American Red Cross and with local authorities. (Editor’s note: The U.S. Department of Health and Human Services has made exceptions to the HIPAA privacy regulations for facilities responding to disasters. For a copy of their special bulletin on this subject go to: www.hhs.gov/ocr/hipaa, and click on "Hurricane Katrina Bulletin: Disclosing PHI in Emergency Situations.")
"We were moving patients in and out by rickshaw, by ambulance, by aircraft," recalls Mary Frost, RN, trauma coordinator at Texas Children’s. "We even had information on a patient who was put on a C-130 prior to the storm."
The forms started as rough notations on pieces of paper, but "that began to become unruly," says Frost. "We set up an Excel spreadsheet with the patient’s name, age, and of course, everybody was from New Orleans."
She and Upton ended up with 5,000 names, but the original form could be searched only alphabetically.
They then began collecting data from other hospitals on patients they were seeing and shared that information with the aforementioned organizations. "We started to fax and e-mail information back and forth," recalls Frost. "The problem was that everybody had a little different format and take on how to send the information."
Preparing for Rita
After the Katrina crisis had subsided (but before Rita’s arrival), the two decided to create one centralized type of form for patient information. (See form.) It included the patient’s name, date of birth, shelter or location they were coming from, chief complaint, the type of transportation that was needed, where they were going to, and who took the call.
"All of that was entered into a database that a biostatistician from the health department developed," says Upton. "With that, we were able to search by name or key data element — hospital, city, transported to,’ and so forth — to find our patients. If you typed in a last name, you could go back and find these people for folks calling in, or for the Red Cross."
"That unruly spreadsheet was now searchable," says Frost, and it wasn’t any too soon. "Into a system already bursting at the seams from Katrina, [with Rita’s approach] we had hospitals in various stages of opening and closing," she says.
There were fewer hospitals, and some of them could offer only limited services, Frost says. "And for Rita, we had people coming from many different places."
They started coordinating nine counties, and it grew to 30, including parts of Louisiana, Upton says. "At first, nine hospitals had to be evacuated, but we ended up with 19 that had to be evacuated," she says. This took 19 facilities out of the search capacity queue, which had been 96, Upton says. "We lost a Level three trauma center and numerous community hospitals," she says.
The new forms worked much better, says Frost, but she and Upton still are not satisfied. What they want now is a statewide tracking system, she shares. "We realized a disaster like this may not affect just your area," Frost says. For example, they were sending people to Austin, Dallas, and El Paso. "This way, we can continue tracking patients wherever they are sent," she says.
Frost says there’s no reason EDs in other cities can’t do what she and Upton have done, but they shouldn’t assume the same exact forms will work just as well.
"Everybody needs to customize the form for what they want to accomplish," she says.
Every day during Hurricane Rita their mission would change, and they noted it on a white board behind them, Frost says. One day that mission might be the evacuation of a hospital; the next day, it might be nursing homes, Upton says. "What you would end up with was multiple manifests and a summary sheet over it," she says.
Whatever the challenges, the new form proved successful. "We coordinated care for 2,400 patients," says Frost. "In the end, there were only two requests we could not find on our end, and we had not coordinated them."
Source
For more information on patient tracking forms, contact:
- Lori Upton, RN, Assistant Director, Emergency Services, Texas Children’s Hospital, Mary Frost, RN, Trauma Coordinator, Texas Children’s Hospital, Houston. Phone: (832) 824-1000.
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