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Natural disasters can happen to any of us and we need to prepare accordingly.
"(Natural disasters) can happen to any region and any provider, and all of us need to prepare accordingly."

In command

Preparation leads hospitals through disasters

By Gail Donovan
Posted: December 8, 2012 - 12:01 am ET

When superstorm Sandy slammed into the New York metropolitan region, healthcare delivery was immediately challenged in unprecedented ways. Major hospitals, including those serving our poorest and most vulnerable New Yorkers, were severely damaged and forced to evacuate. Destruction to homes and property made hospitals that were still operational the only havens for those with no place else to go.

St. Luke's and Roosevelt hospitals, members of the Continuum Health Partners network, took in more than 130 patients over a 36-hour period from evacuated hospitals, with many of these patients requiring critical care. With most of Lower Manhattan in the dark for several days and neighboring facilities out of commission, Beth Israel Medical Center, another Continuum hospital, became the sole inpatient hospital and emergency room below 57th Street, an area equivalent to one-third of Manhattan.

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Beth Israel remains the major healthcare provider in this large swath of New York City. While other hospitals forced to close are restoring services as quickly as possible, it remains unclear how long inpatient services in particular will remain at diminished capacity.

I refer to what we are going through at Beth Israel and other hospitals as “maintenance surge”—managing an extreme and continuous increase in utilization. It is a new phenomenon to the Northeast, a part of the country historically sheltered from natural disasters. But it is not new to healthcare. We witnessed similar consequences following other disasters, most recently in the Gulf Coast after Hurricane Katrina in 2005. But now having experienced it firsthand, and in such magnitude, one thing is certain: It can happen to any region and to any provider, and all of us need to prepare accordingly.

It begins with regional, systematic preparation. The Continuum hospitals provide one-quarter of the hospitalized care in Manhattan, but we are one component of one of the world's largest and most complex regional healthcare systems. What aided our city and statewide responses was the coordinated effort of a well-orchestrated command center with participation from organizations including the New York City Office of Emergency Management, New York State Department of Health and the Greater New York Hospital Association.

Implementation of a coordinated regional response is something we continually hone and rehearse—and it proved enormously beneficial during Sandy and in its aftermath. Most importantly, the command center helped appropriately divert evacuated patients to hospitals with capacity and advocate for essential resources from other agencies and industries.

Eventually, command centers disengage after the worst is over, or move on to other important matters. While certain support remains in place, service organizations, such as hospitals, essentially are left to manage, sometimes for extended periods of time, their own fluctuating needs and demands. That is why it is essential that every hospital or hospital network have a well-tested emergency preparedness plan, as required for hospital accreditation by the Joint Commission.

Tremendous emphasis on communication allowed us to make educated decisions about maximizing resources at all of our sites and how to best maintain our ability to be accessible to our communities and beyond. Our first duty is to remain a 24/7 community resource. But we also have an imperative to remain open during crises and to be prepared for demands beyond our traditional scope of services.

When hospitalized patients needed evacuation, Beth Israel was already functioning on generator power and taking care of patients beyond its normal census. But thanks to our system-wide preparedness initiative, we were able to quickly determine that St. Luke's and Roosevelt could take in many of the patients.

Weeks after the onslaught of the storm, our “maintenance surge” continues—and with it many ongoing challenges. Discharge planning remains a major focus.

Staffing also remains critical. Beth Israel increased staffing in its ER to ensure that quality of care and patient safety were not compromised. Some of the displaced physicians and staff from shuttered hospitals have been hired to temporarily help in this effort.

Prioritizing access for patients requiring critically needed surgery also remains an ongoing focus. We are just now seeing a return to a normal schedule of electively scheduled, nonurgent surgeries. Nevertheless, we are still delaying some of these cases to free up operating-room time for physicians from shuttered hospitals to perform urgent surgeries.

We have learned a valuable lesson from this experience: The importance to build into care delivery the flexibility (through infrastructure, staffing and other essential resources) to accommodate patient surges, particularly as inpatient care shrinks and healthcare planning focuses more on outpatient care.

Gail Donovan, COO Continuum Health Partners
One major issue will still need to be addressed: financial restitution. Given the massive destruction caused by Sandy, it could be months before New York City's regional healthcare delivery system can get its hands around these figures. Until then, we press on. Efforts continue to maintain an appropriate response to maintenance surge, and to begin assessment of the financial impact, facility needs in the future and basic restoration of our fractured healthcare delivery system.

Gail Donovan is executive vice president and chief operating officer
for Continuum Health Partners, New York.

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