By Jeni Miller
Public health emergencies (PHEs) can happen at any time. If not handled correctly, PHEs can quickly throw a hospital and its staff into a tailspin. But if a hospital is adequately prepared for a PHE, it can benefit other healthcare partners and the community.
When Hurricane Ian ripped through the eastern United States in September 2022, hospitals in Florida and other coastal states had to adapt and respond in haste. Case managers played a part in the success of some hospitals’ responses because of their ability to see the big picture and keep the flow of patients moving smoothly.
Kelli Burba, BSN, RN, ACM-RN, executive director for care management for AdventHealth’s Orange, Seminole, and Osceola campuses, notes one element of the organization’s success in managing the effects of the hurricane was creating a strong central communication system.
“We have a robust command center. We keep tabs on the individual campus command centers, as well,” Burba says. “In communities where there are post-acute needs, bidirectional needs, it’s important to get messaging out to sister facilities, especially those who’ve lost power. You have to make sure that the dialysis centers are OK, and determine which ones are planning on being open. In general, knowing who is going to remain open and who will be off during the storm — that’s crucial.”
Burba suggests keeping all campuses updated on transportation challenges. Often, it’s a “smaller amount of people that can come in during a storm, so sometimes there isn’t a lot we can do as far as discharges go once it is underway,” she adds.
Mari Torres-Luengas, MSML, BSN, RN, ACM, system care management director at AdventHealth, recommends if transitioning patients before the storm is preferable because curfews and similar parameters can otherwise impede timely discharges.
“It also is important to engage other hospitals if they are evacuating patients, and to find out where they are going when evacuating to post-acute facilities in the region,” Torres-Luengas notes. “[Case managers] need to have an awareness of what is happening in the surrounding regions due to capacity.”
It is critical for case managers to stay abreast of the community and who is shut down, which nursing homes are under water or shut down, or what issues are taking place in the local facilities, Burba says.
AdventHealth holds PHE preparation drills throughout the year. These drills can prevent panic and confusion later. While a command center may be the best way to organize this kind of preparation and communication, smaller health systems and hospitals can design a plan.
Regardless of whether there is a command center in place, forming relationships with community partners and other hospitals can make a difference during a PHE. Torres-Luengas notes approximately 20 to 25 AdventHealth facilities collaborate. AdventHealth has a strong relationship with 65 other facilities that are not part of the collaborative.
“Because of that, it’s easy for us to send a text message or email and they reply right back because the relationship has been fostered year-round,” Torres-Luengas explains. “These are our partners.”
AdventHealth’s Central Florida location sees many tourists, which contributes to capacity issues. They must be “continually engaged with partners even if there is not a disaster, just because we often have patients waiting to be seen due to capacity issues,” Torres-Luengas says.
In addition to PHEs, hospitals should always be ready even during lesser disasters. “It’s not always a hurricane here, but really bad thunderstorms, too,” Burba notes. “Even then, we need to make sure that we’re sending patients to the appropriate places and not all to one emergency department.”
If there is time before a PHE is called, case managers might find it most helpful to prepare by putting in “extra-long days prior to the storm or emergency to get patients out earlier, and thereby lessen the burden to the hospital and staff,” Burba explains.
This way, if the hospital cannot discharge patients for a day or two — or if staff cannot leave the campus and need to stay on site — capacity will be freed for people who truly need to be there during the emergency.
For the frontline team, another priority is adapting to rapid changes and knowing how those changes might function. For example, a case manager should know there are waivers in place regarding the Two-Midnight Rule during an emergency. In some cases, insurance might waive the typical rules for skilled nursing facilities. Knowing what could change and shifting from the normal protocol, knowing all the steps may not apply during these disasters, can be crucial for case managers.
Burba and Torres-Luengas agree no matter the situation, it comes down to a combination of excellent communication and robust education and preparation.
“It’s the work we do all along,” Burba says. “When a situation comes up, you have to have good community relationships already, have their contact information already, and be prepared to phone them and keep in contact to discuss what they are seeing and what issues they are having. Keeping teams up to speed, educated, prepared, and really keeping that communication open is most important.”
Every PHE provides an opportunity for learning and fine-tuning processes. AdventHealth’s comprehensive system has been tweaked and improved over the years.
“We learn from every storm … the importance of communication and becoming focused on what is happening in the community,” Burba shares.
The process of creating different teams of staff to serve during a PHE has been developed over time. They check those lists throughout the year to be as prepared as possible.
“I recommend ensuring that the Team A and Team B list is revisited more than once a year because you don’t want to wait until the last minute to find out [the staff] aren’t available,” Torres-Luengas explains.
Likewise, Burba recommends hospitals ensure their handbook is up to date and makes sense. A good time to do this is following a disaster so lessons learned can be quickly and easily incorporated.
Public health emergencies (PHEs) can happen at any time. If not handled correctly, PHEs can quickly throw a hospital and its staff into a tailspin. But if a hospital is adequately prepared for a PHE, it can benefit other healthcare partners and the community.
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