Ice storm puts staff in ED to the test
In early January, Mansfield, OH, was hit by an ice storm. "We essentially had a town without power for six or seven days," recalls Anthony Midkiff, MD, FACEP, director of emergency services at MedCentral/ Mansfield Hospital. While dealing with operational issues, such as using generators to provide electrical power, the ED also had to deal with a unique set of medical issues.
"We had a lot of staff falling in the parking lot," says Midkiff. Hospital employees salt all sidewalks and the parking lot when winter weather hits. When particularly bad spots are reported, as in these cases of staff injuries, those areas are re-salted.
Additionally, "there were patients with carbon monoxide poisoning, from using stoves, kerosene heaters, or generators to keep warm," Midkiff says. There also were more common problems, such as sprained ankles, fractures, and an increase in coronary artery disease-related problems when people tried to shovel out of the snow, he recalls.
In all, the ED saw 5,000 patients that month, when it normally would see about 4,000. This increase was a result not only from treating more local patients, but also from treating injured workers who had come from as far away as Washington, DC, to help restore power.
How did Midkiff deal with the situation? "Basically, we did what we do not like to do: Put people in the hallways, in an area behind the department," he says. "Staff worked more shifts than normal and longer shifts — not that we had a set schedule."
In light of the experience, Midkiff has instituted several changes in his ED, and most of those changes relate to keeping patients warmer.
"We are now fully stocked with blanket warmers — even in the summer," so they are available whenever the first winter storm hits, he says. "We now have a fluid warmer for [intravenous] fluids. We have stocks of food and bottled water, and space set aside to overflow into if we have the need."
As for the dramatic increase in volume, Midkiff says he’s not sure how an ED manager can prepare for a 25% jump in patients. "One thing I would advise is not to hesitate to call a disaster or rely on disaster resources in the hospital when you are being overrun like that," he says. "There were a couple of days we didn’t do that when we probably should have."
Formally calling a disaster brings additional resources into play — more staffing, for one, Midkiff continues. "We go through the nurse manager in administration to call a disaster when our resources are overwhelmed," he explains. "She puts out a call to other staff and physicians."
A more direct approach
At William Beaumont Hospital in Royal Oak, MI, ED volume typically increases from about 9,500 monthly to about 9,800 monthly in the winter. While she can’t recall a storm situation similar to that experienced in Mansfield, Linda Reetz, RN, BSN, director of emergency services, has tried to prepare in advance for such eventualities.
During winter the staff is "super-sized" on every Monday and Tuesday. "We know Mondays are historically more busy, and we became concerned about Tuesdays because of patients [without beds] being held over," she explains. When the staff is "super-sized," it increases by about 10%, including nurses, technicians, clerks, and physicians. The normal size of the staff is about 16-22 RNs, and it fluctuates according to historical time of arrival, Reetz explains. They normally have six to eight physicians.
Reetz also instituted a "contingent pool" about 18 months ago. "We have a salary ladder; if they work every weekend for us, they get more money on top of their base, based on the number of hours they come in," she says. The increases can be anywhere from 8% to 24% over typical hourly rates, based on numbers of off-shifts, hours, and weekends, says Reetz. "We’ve gotten good buy-in from staff."
Reetz says having adequate staffing during winter volume surges in critical. "You can pull the overtime and offer them money, but if the staff is working 16-hour shifts a day, it’s not good for them or the patients," she explains.
Reetz also strives to optimize staff health during the winter. "In wintertime months, we do more educating about hand washing and keeping yourself healthy and well," she notes. They also offer voluntary inoculations and hold them in the ED, Reetz says. "It’s a scheduled event through our employee health service department," she says.
To further ensure optimal staff health, the ED encourages patients who have an airborne illness to place a mask on and take a box of tissue paper, which are dispensed at the greeter’s desk upon arrival. "If the patient doesn’t get the hint, then the staff will ask them to apply a mask and utilize [tissues]," she adds.
Sources
For more information on how to handle patient increases in the winter, contact:
- Anthony Midkiff, MD, FACEP, Director of Emergency Services, MedCentral/Mansfield Hospital, 335 Glessner Ave., Mansfield, OH 44903. Phone: (419) 526-8000.
- Linda E. Reetz, RN, BSN, Director of Emergency Services, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI 48073. Phone: (248) 898-6260. E-mail: [email protected].
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