How Florida hospitals coordinated care during Hurricane Ian

Amid the destruction caused by Hurricane Ian, workers at DispatchHealth received a call for an 82-year-old man stuck in his home and in need of medical treatment for swollen legs and shortness of breath. 

Power was down at the man’s Lee County home in southwest Florida, leaving him unable to elevate his legs in his electric recliner or turn on the air conditioning, and his usual physical therapy and wound care service teams could not reach him because of the storm, said Dr. Adam Perry, Florida regional medical director for DispatchHealth, a Denver-based home healthcare company. 

“That's just how quickly things change when the power goes out for older adults who have complex medical needs and rely on other people to help them,” he said. 

Luckily, members of DispatchHealth’s team were able to implement their emergency management plan, delivering medication and providing the level of care the man needed in his own home, Perry said. 

Hurricanes pose great risk to patient safety and quality as severe flooding can cause homes and hospitals to lose access to clean water, power and other resources needed for treatment. 

Across Florida, more than 100 people died because of Hurricane Ian, many of whom drowned or couldn't access medical care, according to reporting by the Washington Post. 

Because the Sunshine State frequently confronts extreme weather, most hospitals have detailed processes in place to ensure safe, high-quality care during such disasters, from patient transfer and care continuity plans to remote monitoring teams and strategic partnerships, said Mary Mayhew, president and CEO of the Florida Hospital Association.

“The care and safety of hospital patients is absolutely the number one priority as emergency management plans are continually improved upon,” Mayhew said. During power outages, for example, all Florida hospitals have generators that are regularly tested and most have access to alternate sources of fresh water, either from tank trucks or local ponds, she said.

Coordination between the state, counties and hospital command centers is essential to account for all staffed beds that are open for patients who need to be evacuated, as well as the ground and air transport available, Mayhew said. 

Before Hurricane Ian made landfall, HCA Healthcare leaders were determining what hospitals would likely face the greatest risk of damage from flooding and storm surges. They also mobilized the Nashville, Tennessee-based for-profit health system’s supply chain to deliver bedding supplies, food, water, oxygen and medications. 

The health system used data analytics to identify high-acuity patients based on age, physical characteristics and whether they were in intensive care units or on certain intravenous drips, said Dr. Ravi Chari, president of HCA Healthcare’s West Florida Division. 

HCA Healthcare hospitals share an electronic health records system, so clinical teams receiving transfer patients were able to access medical histories, treatment protocols and medications to provide seamless care, Chari said. 

HCA Healthcare evacuated four hospitals in the days before Hurricane Ian, Chari said. The company worked with facilities and emergency medical service teams in nearby counties to determine the safe and effective ways to transfer 270 patients, he said.

AdventHealth Kissimmee employees came to work right before Hurricane Ian hit with air mattresses and days' worth of clothing and food, said Danielle Favorite, a director of nursing at the hospital, which is part of an Altamonte Springs, Florida-based health system. Workers hunkered down as the facility became surrounded by several feet of water, she said.

“Anytime that we are approaching hurricane season, we do prep and put our [employees] on a Team A and Team B,” she said. “Team A is the team that will stay with us through the storm and Team B is what we call our recovery team. They come in as soon as the roads are clear and relieve us so we can go home and get rest,” Favorite said.

By making sleeping arrangements for hospital employees, patients can still have access to around-the-clock care without worries that staff won’t be able to get to work because of flooding, Favorite said. This way, more employees are available to protect patients from water intrusions and other kinds of hurricane damage, she said.

When triaging patients during Hurricane Ian, Lee Health of Fort Myers deployed extra resources such as infection prevention specialists onsite to ensure clinicians were following quality and safety procedures such as cleaning central-line devices using boiled water and avoiding patient falls, said Dr. Stephanie Stovall, chief clinical officer of quality and safety at the health system.

Additionally, Lee Health employees had to set up areas for visitors during the storm where they wouldn’t impede the flow of patients or get in the way of their care, Stovall said. “We always take into consideration the mental and emotional safety of our patients by making sure that we inform them of what’s going on around them and notifying the public when we have to make changes to how we care for our community members,” she said.

Procedures also were in place to provide care for those who couldn’t make it to a hospital because of the storm.

Before DispatchHealth sent out clinicians to home health patients following Hurricane Ian, the company had to make sure that its workers were safe and that roads were clear and free of water and downed power lines, Perry said. The care teams also had to verify their communication systems were working, and that they had access to medical records.

“Even when we can't communicate with primary care providers or specialists in a two-way conversation as we usually would, we do have very valuable information through EHR integration with our healthcare systems,” he said.

DispatchHealth teams from the Miami and Fort Lauderdale areas came to bolster DispatchHealth employees near Cape Coral in southwest Florida, bringing cars, medications, technology and supplies for point-of-care testing at home.

The company also partnered with health systems to share resources and onboard patients that hospitals weren’t able to access care for because of issues with electricity, water and capacity, Perry said. DispatchHealth is currently integrating its services with one partner that has a telehealth platform in order to provide a broader spectrum of care for the community, he said.

“Asking for and enthusiastically getting help from the rest of the state is really what's helping our teams and helping Fort Myers right now,” Perry said.

Another safety and quality focus for HCA Healthcare has been ensuring its team members have access to fuel, food, laundromats, showers, portable generators, tarps for roofs and other key supplies to preserve their homes, Chari said. Employees affected by Hurricane Ian can also apply for grants through the health system’s Hope Fund and seek help from its employee assistance program, he said.

“It falls under the umbrella of caring for our people who will care for our patients,” Chari said. “Having committed staff who believe in our organization because we support them gives us the best chance to have the best care.”