CMs face challenges of Hurricane Katrina
Hospital cared for thousands of evacuees
For case managers at Our Lady of the Lake Medical Center in Baton Rouge, LA, Hurricane Katrina presented challenges most people can’t even imagine.
"As people left New Orleans, Baton Rouge was quickly overwhelmed by the number of patients with special needs. Our Lady of the Lake was the first responder to the special needs shelter here in Baton Rouge where the majority of people needing medical care were triaged," says Lesley Tilley, RN, BSN, CCM, divisional director of nursing and administrator of medical services.
The hospital’s 20 nurse case managers and 13 social workers put in 12-hour days for an entire week, helping keep the situation calm and providing support and care for the patients wherever needed.
The hospital was quickly inundated with hurricane evacuees who had tremendous psycho-social needs, spotty medical records, and no place to go after discharge. Insurance information for most patients was not available, and the web site that approves Medicare days was down.
The patients who came to the hospital had been through a tremendous trauma and needed a sympathetic ear to hear their story.
"During a normal cycle, the case managers go in and assess the patients, develop a plan of care and a discharge plan. They’re great at it, but the needs of these patients were overwhelming," Tilley says.
Assessments typically took case managers and social workers twice as long as they would under normal circumstances, and discharge planning was hampered by the fact that there were few places for the patients to go and the transportation services were overwhelmed.
"We would have 20 patients in the hospital ready for discharge, but the staff couldn’t just send them home with no place to live. All of these patients needed a place to stay and a ride home," Tilley recalls.
The hospital used its fleet of vans to transport patients back to the special needs shelters and bought bus tickets and airplane tickets for numerous patients whose families were in other areas.
"We didn’t want to put them in a shelter if we could avoid it, so we found the family and helped them get home," she says.
The case management department’s community resource book was an invaluable resource following Hurricane Katrina. Staff from all parts of the hospital used the information to find community services for their patients.
"Having up-to-date information that is available to everyone in the hospital is a big plus. The case managers and social workers were so overwhelmed that we had to call on the other departments to help with post-acute transfers," Tilley says.
Except for a few patients who were directly admitted from New Orleans hospitals, the majority of patients with health care needs coming out of New Orleans were triaged at two special needs centers. Baton Rouge hospitals provided the supplies and staff to care for these patients for many days.
Many of the patients who needed hospitalization were directed to Our Lady of the Lake.
"Our hospital is the only one in the area with some special services. We have the largest pediatric unit and pediatric intensive care unit in the city, the only neurosurgical and trauma programs. The doctors tried to triage the patients because they didn’t want to overburden our hospital with patients that could be treated elsewhere," she says.
In the first few days following Hurricane Katrina, case managers and social workers at Our Lady of the Lake Medical Center concentrated on crisis management rather than their regular duties, helping the hospital treat and identify community services for the tremendous influx of patients coming from New Orleans.
The social workers spent some of the first few days in the emergency department (ED), helping people who were being discharged find a place to go and assisting them in locating family members so the ED staff could concentrate on treating patients. It was then staffed by the outpatient mental and behavioral health team because the greater need was for the social workers to be on the acute units, Tilley says.
The case managers spent their time at the bedside and in the ED, helping take care of patients. They helped staff a special triage area for patients being transferred from other hospitals.
"When patients came in from other hospitals, the case managers and nurses assessed them, got a physician, and admitted them straight from there," Tilley says.
The hospital set up a prescription writing area, staffed by nurse practitioners and physicians where people who needed only a medication refill could get prescriptions.
Some patients who were transferred to the hospital came with a makeshift medical record. Others came from the special needs center with just a triage form.
About a dozen patients, mostly infants with heart problems, were transferred to Our Lady of the Lake from Children’s Hospital in New Orleans along with their entire record. They were accompanied by nurses and a pediatric heart surgeon.
"Some were airlifted, some came by ambulance, and others were brought in their car by their parents who were desperate to see that their children got care," Tilley says.
Our Lady of the Lake and other Louisiana hospitals go on disaster alert every time there’s a hurricane in the Gulf of Mexico, whether it’s aimed at Mississippi or Pensacola or Louisiana.
The day before Hurricane Katrina was expected to hit, the disaster plan went into effect. The hospital leaders and department heads made arrangements to stay at the hospital and urged their staff to do so as well.
The hospital set up a child care center in the auditorium for children of employees and accommodated the staff as much as possible.
A command center headed by the administrator on call operated 24 hours a day and coordinated communications with the Louisiana Office of Emergency Preparedness (OEP) and the Louisiana Hospital Association, which coordinated the transfer of patients from other hospitals.
Patient care services sets up an employee pool of nonclinical staff to help with the telephones and other duties, freeing up the clinical staff to care for patients.
Every two hours, the hospital called the OEP to let them know how many beds and what kind of beds were available.
Transferring hospitals also called the OEP to see what beds were available for their patients.
The federal law mandating that hospitals have to take any patient that presents was suspended for the first 72 hours following the hurricane, allowing the hospital to send patients with less serious needs to other cities.
"We had all these systems in place for Katrina, but as much as we prepared, the hospital was simply overwhelmed by the influx of patients," Tilley says.
After the arrival of storm evacuees began, case managers in the managed care department e-mailed the payers, notifying them that the case managers were working at the bedside and in the ED taking care of patients and wouldn’t be able to conduct utilization reviews in the days following the storm. Nurses from the revenue management department helped during the first week, doing utilization review as needed.
A number of patients transferred from New Orleans had insurance from companies that do not contract with Our Lady of the Lake. Those insurers agreed to pay the bill.
More than three weeks after the hurricane hit, the hospital’s business office had begun the arduous task of backtracking to determine what kind of insurance coverage the patients they treated had.
The hospital never lost power during the hurricane, although a hospital-owned nursing home two blocks away lost power for two days and many staff ended up spending the night at the hospital because their homes had no power.
The hospital’s capacity is 600, with a normal census in September of 450. Three weeks following the hurricane, the census was 570.
"In the weeks after the hurricane, we rescheduled all the elective surgery that was postponed so we could take care of the patients coming from New Orleans. The hospital is still feeling the effects and trying to catch up," Tilley says.
(Editor’s note: Lesley Tilley may be contacted at: [email protected].)
For case managers at Our Lady of the Lake Medical Center in Baton Rouge, LA, Hurricane Katrina presented challenges most people cant even imagine.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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