Transcript Slide 1

Centers of Care
Nassau University Medical Center
A. Holly Patterson Extended Care Facility
Dialysis Center at A. Holly Patterson
South Ocean Care, LLC
Long Island FQHC
Elmont • Westbury • Hempstead • Roosevelt
“Surviving Sandy: Hospitals Make the Best Out of a Terrible Situation”
Annual Membership Meeting - American Hospital Association
Monday, April 29, 2013
Arthur A. Gianelli, MA, MBA, MPH
President and Chief Executive Officer of the NuHealth System
2201 Hempstead Turnpike
East Meadow, NY 11554
516.486.NUMC
www.nuhealth.net
NuHealth in a Nutshell
• NuHealth is a public benefit
corporation that operates:
– The Nassau University Medical
Center (NUMC) – 531 beds
– The A. Holly Patterson
Extended Care Facility (AHP) –
589 beds
– Five community health centers
in conjunction with the Long
Island FQHC, Inc.
• NuHealth is Nassau’s safety
net provider, providing care to
residents living predominantly
in the county’s 33 federally
designated medically
underserved areas.
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Long Island – Susceptibility
to Flooding in Major Storms
NUMC
AHP
LBMC and
Nursing Home
Long Island is extremely susceptible to flooding from major hurricanes. During the last two
major hurricanes (Irene and Sandy), NUMC and AHP sheltered patients from the Long Beach
Medical Center and its associated nursing home.
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Before the Storm Hit…
 Friday, October 26th: Our Sandy journey began. We spoke with the
leadership of the Long Beach Medical Center (LBMC) and agreed that, as
with Hurricane Irene, we would partner on evacuating the hospital and its
affiliated nursing home (the Komanoff Nursing Home).
 Saturday, October 27th: Preparation day. The team at LBMC faxed over
face sheets with patient information and prepared transfer notes,
including medical, pharmacologic, nursing, and other issues related to the
hospitalizations. Our team worked on the challenge of accepting 55 acute
care and 35 nursing home patients, such as staffing, beds, food,
medications, and facility support. The 20 patients from LBMC’s inpatient
psychiatric ward required the opening of a previously closed unit at
NUMC.
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Before the Storm Hit…
• Sunday, October 28th: Transfer day. LBMC staff transported their patients
and a triage team (chief medical residents, a hospitalist, psychiatrists,
nursing staff) met them near their entrance point. They reviewed patient
records, assessed medication regimens, and facilitated the admissions
process. Over a period of 6-8 hours, these patients were integrated into
our hospital. At the same time, AHP took in 35 residents and, because it
was already near capacity, admitted these residents to a redesigned
auditorium.
• And then we awaited the onset of the storm….
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In the Wake of the Storm….
 NuHealth experienced a series of dramatic and unprecedented
operational challenges in the wake of Superstorm Sandy. These
included:
 Interrupted Communication: Cellular devices worked haltingly,
internet access was unreliable.
 Increased Census: Within 72 hours of the storm, NUMC’s census rose
from 330 (pre LBMC transfer) to a peak of 570 patients. AHP’s census
exceeded 620 (its normal operating census is approximately 570
residents).
 Markedly Different Census: The patient population filling our beds was
increasingly frail elderly who lacked support from relatives or home
health agencies.
 Increased ED Utilization: NUMC’s ED was inundated with patients
seeking O2 tank refills, dialysis, and prescription replenishment. We
also saw a number of cases of carbon monoxide poisoning.
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In the Wake of the Storm
(cont)…
 Staff home displacement: Numerous employees sustained
significant property damage, many losing their homes.
Our employees were victims as well as first responders.
 Staff shortage: NuHealth was not staffed to sustain safe
care for a census as large as 570 in its hospital and 620 in
its nursing home.
 Fuel shortage: Though NuHealth had arranged regular
shipments of fuel, employees were not able to fill up their
vehicles at gas stations, due either to limited supply or
excessive lines.
 No place to which to discharge patients: With south shore
nursing homes knocked off line, it was immensely difficult
to find safe placement for patients who could be
discharged.
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NuHealth’s Response
• We kept doing what hospitals do – 7 babies were delivered DURING the
height of the storm.
• We sustained highest HICS level for nearly three weeks.
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Multiple daily incident command center meetings.
Meetings as “standard work”.
ICS available as central point of communication.
Regular updates from ICS posted on web, made available to media, and
disseminated to employees and to Board of Directors.
– Participation in North Shore – Long Island Jewish Health System emergency
response program.
– Constant communication and coordination with county, state, and federal
officials.
• We created a fuel dispensing and rationing system for employees /
partnered with local gas station to make fuel available to hospital and
nursing home employees.
– Approximately 3,000 gallons of gas were distributed to staff, with another 300
gas tickets provided to staff to obtain fuel at local gas station when it opened.
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NuHealth’s Response
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Credentialed and deployed approximately 165 medical professionals from LBMC
to supplement our staff.
Established transportation system for patients to and from emergency shelters.
Created car pool communication board to help employees conserve fuel and get
to and from work.
Deployed family practice residents to emergency shelters to triage patients and,
ideally, keep patients away from the hospital.
Sent discharged patients home with three day supply of meds to try as best as
possible to avoid immediate readmissions.
Created capacity wherever possible (re-opened units under renovation, hallway
beds, use of atriums, etc.) to house patients at the hospital.
Created capacity in the hospital to permit staff on multiple shifts to sleep, shower,
and eat.
Quickly renovated empty resident housing to make units available to employees
who lost their homes (also connected these employees with other social support
services, such as the local food rescue organization).
24/7 crisis counseling provided to impacted employees.
Conducted a fund raiser through Foundation to support displaced employees.
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Our Family Medicine Residents
at the Emergency Shelter
• Our Team of family medicine
residents were deployed to
staff medical services at the
Nassau Community College
hurricane shelter beginning on
Wednesday, October 31, 2012.
• Our mission was to assist
those in need of medications
due to chronic medical
conditions, but also as best as
possible limit the number of
patients sent unnecessarily to
our hospital.
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Yet, We Still Needed
Assistance….
• On the Friday following the storm, my Chief Nursing
Officer contacted me to indicate that she could no
longer reliably and safely require her staff to report to
work. Our census remained at dangerous levels,
despite every possible effort to discharge patients.
• NuHealth contacted Nassau County Emergency
Management as well as the New York State
Department of Health to request – urgently – clinical
staff to supplement our beleagured workforce.
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DMAT and NPHS to the
Rescue
DMAT team in our ICS…..
A “unique” model….
• The federal government
deployed an 50 member Disaster
Medical Assistance Team (DMAT)
as well as a National Public
Health Service (NPHS) team.
• The DMAT was integrated into
NUMC’s inpatient and emergency
medicine units, creating what we
were advised was a unique model
of emergency response.
• The NPHS team provided realtime crisis counseling to our staff.
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The DMAT Deployment made Our
Sustained Response Possible
The DMAT Team….
How the Team worked….
• To support our response to
Superstorm Sandy, the federal
government sent 50 health care
professionals (physicians, nurses,
paramedics, x-ray techs, and
pharmacists) from Texas, Ohio, and
Kentucky.
• Though the usual model for DMAT
is to work in tents outside of
hospitals, the integration of the
DMAT clinical professionals into
our clinical teams worked flawlessly
and elicited extraordinarily positive
feedback from our staff and from
the DMAT team.
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The Pressure Subsides….
• By mid-November, our hospital census
receded to manageable levels, and NuHealth
was able safely to transition from its reliance
on the supplemental support provided by
DMAT and NPHS professionals.
• It was at this point that NuHealth was also
able to ratchet back and wind down its
incident command operations.
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Some Lessons Learned
• Utilize the management structure
you are most comfortable with;
an emergency is no time to try
something new.
• Utilize the LEAN concept of
“standard work” to run your ICS.
• Broaden your preparedness plans
to:
– Include responses for frail elderly,
patients who need dialysis, and
patients without primary care
options.
– Include extended sheltering of
employees.
– Address possible gas shortages.
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Some Lessons Learned
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Identify multiple methods to
communicate with all shifts (in a postincident survey, this was identified as our
greatest weakness).
Work with your local or state
Departments of Health to put in place
regional strategies to address, in an
emergency, patients who need dialysis,
frail elderly who cannot access home care,
etc.
Work with your local or state
Departments of Health to develop clinical
staff redeployment strategies.
Take advantage of emergency
preparedness training sponsored by the
federal government, such as through the
Department of Homeland Security’s
Center for Domestic Preparedness.
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I’m Very Proud of the
NuHealth Team….
“I was very impressed with the command execution
of the command center team as well as your
administrative officers. They get it! You all
understand the Incident Command System and you
are very effective and intuitive. In my many years of
experience, I found it to be very well run!
Not only are you trying to mitigate a crisis, but you
are primary victims, yet still continue to put
patients’ needs ahead of everything. You are to be
commended for this!
You had your priorities straight. The things you did
to care for your people, I have never seen that level
of command organization in a hospital.”
DMAT TEAM LEADER
KEVIN HOBAN
FIRE CHIEF
MESILLA, NEW MEXICO
November 9, 2012
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