Christina's Considerations

Getting It Done: Strategies for Clinical & Financial Success

Dr. Ken Cohn is one of my virtual friends and like me, a writer and blogger.  He lives on the East Coast and at one time did live here in Santa Barbara, however the Internet has facilitated our connections and collaborations on topics of shared interest.  As in the case with some of my other virtual friends, I'm sure one day we will meet in person -- most likely at an ACHE Congress on Healthcare Leadership.

Last year his latest book Getting It Done was published.  He and his co-editor, Steve Fellows, have pulled lessons learned from some of the best and brightest in the healthcare profession on a broad range of topics. I enjoyed the stories, ideas and peaking inside a little unfamiliar territory.  Here are a few of the chapters and concepts that struck me.

Disaster Preparedness for Healthcare Professionals Important reminders:

• Disasters, like dragons, have long tails!
• You don't know what you don't know, but you could!  
• The best surge capacity response is not to have a surge!  
• It's all about big guys with big guns!  
• Has your CFO attended disaster training? Because, the answer is money!

Overcoming Rural Healthcare Challenges - The complexity that sometimes leads to the marginalization of rural hospitals and in many cases their one and only general surgeon.

Launching and Innovation Revolution in Healthcare - Great examples of breaking out of the old.  I especially like the red zones and Chocolate Cafe'!

Documentation as Destiny: A Tool for Survival  Why physician documentation is the key ingredient in the determination of payment.

Building a Functional Operating Room Culture  Hummm!!  I can see how the best candidate for OR medical director is "a retired surgeon or anesthesiologist who likes surgeons and has a background as a high school teacher with a degree in psychiatry."  This wonderful chapter also includes the quote "The best way to predict the future is to invent it." (Kay 1989)

Innovations to Address Disruptive Physician Behavior  Comprehensive approach and series of progressive interventions and ongoing monitoring, but don't forget docs aren't always the hospital's bully. Use this guidance to address them all for safe and high quality care.

Coaching Healthcare Teams to Improved Performance  Breakdowns in communication and poorly managed conflict drive suboptimal team performance and undermine the quality and safety of patient care.

 

Patient Care in a Crisis

By now, many of my regular blog followers should have figured out I'm a girl from New Orleans and I also have a specific interest in emergency preparedness and disaster planning, especially for hospitals.  Once again, I get to post about something that blends several interests.

I received a link to the premier issue of the enhanced digital magazine Security Management . It includes an article, Patient Care in a Crisis, that looks at the decisions healthcare providers made in New Orleans in 2005 when Hurricane Katrina came ashore. It explores issues, such as, security and the choice between shelter-in-place and hospital evacuation.  The lessons learned and information shared will certainly be of value to those readers with an interest in disaster planning and preparedness.  One fact that I did not know before this article was that 35% of the dead bodies recovered after Katrina were found in hospitals.

However, the interactive nature of this eMagazine with embeded short video clips, podcast and an expandable digital map of the U.S. with the number of staffed hospital beds available for all U.S. Zip Codes will be especially interesting to those of you who enjoy new media and emerging technologies. The more interactive nature of this digital magazine does enhance the reader's experience.  

For those of you who like apps, you may also be interested in the article that follows on Life Safety Apps.  It also includes interactive presentation of content.

The digital issue and healthcare feature is available publicly for the month of May - so check it out soon!

What I saw/learned at HIMSS12 - Highlights

It has taken me a while to catch up and recover from being at HIMSS12 last week, but I've finally had a chance to sit down and reflect on what I saw and learned during that busy week.  So below are my higlights:

• Thoughts from Biz Stone: 
  • Opportunity can be manufactured! You can create it!
  • Creativity is a renewable resource. It is infinite! Challenges are fun puzzles; not problems!

• Thoughts about the Future from the Smith and Hobbs presentation on Clinical Mobile Applications: 
  • 500 million people are expected to manage health concerns with smartphone apps by 2015 according to Research 2 Guidance 2010.
    
  • "Drive discovery about behavior, adapting to person and optimizing behavior"
  • The convergence of biology and machine
  • We need to establish risk model taxonomies for consumers, providers and manufacturers for safe & secure apps.
  • We need sensors to pick up signs that an intervention is needed in healthcare, just like our cars are doing today.

• CMS' ICD 10 and Version 5010 Implementation Timeline widget

• Guam HIE Project that demonstrate its Secure Messaging capabilities using the Nationwide Health Information Network Direct Project for coordinated care and disaster communications.

• Kaiser Permanente launched its new Mobile Optimized kp.org app giving members access to their medical records, refill prescriptiosn, appointments and messaging via mobile devices.

• Learned about iTriage's ER CheckIn smartphone app service that hospital staff of incoming patients. iTriage is the same one that made it to my list of top apps for the flu season late last year.

• The There's an App for That presentation demonstrating apps for vision, hearing, sleep, sobriety test, contractions/labor, smoking cessation, heart rate, spirometry, Airstrip, AED, allergy alert, EKG, podiatry, and more.

• The Patient Safety Company promoted their cloud environment and apps for safety and risk.  Also, help you develop your own apps. 

• Seeing MicroBloggingMD a microblogging platform used for secure hospital communications.

• Learning about Happitique which classifies apps for professionals which helps with the sorting process of the thousands of available apps and provides an enterprise mHealth solution. 

• Talking to several people about the move toward BYOD (bring-your-own-device) and the associated risks (including data security) in healthcare environments. (Stay tuned for an BYOD post to come.)

• Experiencing my first "hat interview" as tweeted by @EHRworkflow

• Learning about HealthInfo Island, Health Support Coalition, Cancer Co-Op, AIDS and HIV Support, etc  -- communities on the virtual world 2nd Life.

• And, getting an update from Zac on Louisiana's HIT/HIE activities.

But, the absolute best part of the week was finally meeting several of my blogger friends in person! Talking with them in person gave us a chance to bring our relationship full circle.  Some I just met this past year, but I've known two since first starting to blog in 2005 -- @hospitaltony and @techguy.

Protecting Workers Against Violence is Worth the Cost

I was recently interviewed for an article in Healthcare Finance News about the cost of protecting workers against violence.  It came about because of a ANA survey  looking safety concerns in the workplace and the report that healthcare facilities are not doing enough to keep nurses safe.  While we often think of the hospital, workplace violence can, and does, also occur in nursing homes and ambulatory or private practice settings.

Healthcare worker violence is an issue related to security, which falls under the broader umbrella of hospital safety.  From a general standpoint, healthcare security is important, but competing priorities sometimes get in the way of organizations doing more to secure access to the facility or expend additional resources on training.  Most hospitals and some other healthcare settings do have security staff.  However, security staff can't be everywhere at once and just adding more isn't always the best answer.

The best person to identify when something isn't right (a safety or security risk) in their environment, is the person who works in that environment on a daily basis.  The result is that we must rely on employees and others in the organization to notice and report any suspicious behavior and to be more defensive in their contact with patients, families, visitors and even other staff.  Unfortunately, as an industry we have tried to create warm and inviting environments for the public and healthcare workers have historically been too caring and trusting.

The risks to employee (and patient) security and safety are continually evolving and expanding.  I believe our healthcare organizations must create policy that mandates reporting of any suspicious behavior, threats, and/or violence.  But, they should also create a culture where staff feel safe in doing so.  Organizations can also do more to educate their employees of the evolving risks and help them gain skills to identify risks and respond to difficult situations. 

As it relates to our patients (or their families), they are sicker than they have ever been before and unfortunately the ER is sometimes used as a dumping ground for individuals who belong in other settings.  We need to help our staff become better at identifying threatening behavior sooner and support them with response from other clinical or security staff.  Our organizations also have to develop strong relationships with law enforcement and other community leaders to address concerns as they arise.

As for the investment cost of security ... it is so much less than poor employee morale, high turnover and absenteeism rates, negative media coverage, investigations, fines, litigation, worker's compensation claims, and higher insurance costs. But, keep in mind that a balanced approach is best.

Another one of my posts that addresses the culture of safety and the CEO's role may also be of interest.

Patient Safety Toolkits from AHRQ

The Agency for Healthcare Research and Quality (AHRQ) has sets of toolkits designed to help health care institutions and clinicians provide—and consumers receive—safe, quality health care at various points in the health care process—in the hospital, in the emergency department, in the intensive care unit, in the pharmacy, and when being discharged from one setting to another.

The 17 toolkits were produced under AHRQ's Partnerships in Implementing Patient Safety (PIPS) grant program and include multidisciplinary evidence-based tools, including training materials, medication guides and checklists, that are easily adapted to other institutions and care settings. 

---

Toolkits by Setting Type

Hospital — General 
Emergency Departments 
Hospital Care Units 
Outpatient Settings 
Consumer/Patient Care

Hospital—General – These toolkits contain evidence-based resources to help inpatient facilities improve performance around some of the most common and most serious patient safety problems faced by hospitals today.

• The Emergency Department Pharmacist as a Safety Measure in Emergency Medicine
• Improving Hospital Discharge Through Medication Reconciliation and Education
• Improving Medication Adherence
• Interactive Venous Thromboembolism Safety Toolkit for Providers and Patients
• Patient Multidisciplinary Training for Medication Reconciliation
• Implementing a Program of Patient Safety in Small Rural Hospitals ;
• Preventing Venous Thromboembolisms in the Hospital
• Reducing Central Line Bloodstream Infections and Ventilator-Associated Pneumonia
• Reducing Discrepancies in Medication Histories and Orders at Handoffs
• Testing the Re-Engineered Hospital Discharge (One of my favorites- see Louise)
• Using Military Simulation to Improve Rural Obstetric Safety

Emergency Departments – These toolkits contain resources to help hospitals apply evidence-based safe practices in the Emergency Department (ED) to improve patient flow, implement a multidisciplinary simulation-based safety curriculum, and improve medication safety by implementing a formal ED pharmacist program.

• The Emergency Department Pharmacist as a Safety Measure in Emergency Medicine
• Improving Patient Flow in the Emergency Department
• A Simulation-Based Safety Curriculum in a Children's Hospital Emergency Department

Hospital Care Units – These toolkits contain resources to help hospitals apply evidence-based safe practices.

• Implementing Reduced Work Hours to Improve Patient Safety
• Improving Patient Safety Through Enhanced Provider Communication
• Reducing Central Line Bloodstream Infections and Ventilator-Associated Pneumonia

Outpatient Settings – These toolkits contain resources to help facilities address outpatient medication safety by applying evidence-based safe practices.

• Improving Hospital Discharge Through Medication Reconciliation and Education
• Improving Medication Safety in Clinics for Patients 55 and Older 
  Improving Warfarin Management
• Patient Multidisciplinary Training for Medication Reconciliation
• Testing the Re-Engineered Hospital Discharge

Consumer/Patient Care – These toolkits contain resources to help facilities educate consumers in medication safety and post-hospital care.

• Improving Hospital Discharge Through Medication Reconciliation and Education
• Improving Medication Adherence
• Improving Medication Safety in Clinics for Patients 55 and Older
• Improving Warfarin Management
• Testing the Re-Engineered Hospital Discharge
• Using Military Simulation to Improve Rural Obstetric Safety 

Additional toolkits may be added as they are developed and will be found at http://www.ahrq.gov/qual/pips/

 

 

ACP Ethics Manual on Social Media, Catastrophes, and More

The American College of Physicians has released an update to its Ethics Manual and new or expanded sections include, among others, confidentiality and electronic health records, health system catastrophes, boundaries and privacy, social media and online professionalism.  I really appreciate the manual and have pulled out a few key points based upon the topics I cover often on this blog.

• Communication through email or other electronic means can supplement face-to-face encounters; however, it must be done under appropriate guidelines. Issuance of a prescription or other forms of treatment, based only on an online questionnaire or phone-based consultation, does not constitute an acceptable standard of care. (Exception: on-call situations) (pg 75)

• Shifting principles guide the patient-physician relationship during catastrophes and physicians need to be prepared for decision making and the just delivery of healthcare. (pg 80)

• Physicians who use online media, such as social networks, blogs, and video sites, should be aware of the potential to blur social and professional boundaries.  They therefore must be careful to extend standards for maintaining professional relationships and confidentiality from the the clinic to the online setting.  Physicians must remain cognizant of the privacy settings for secure messaging and recording of patient-physician interactions, as well as, online networks and media and should maintain a professional demeanor in accounts that could be viewed by patients or the public. (pg 81)

 

 All Changes to the Manual since the 2005 (fifth) edition

NIMS: Guidance for HPP 2012

The NIMS objectives for hospitals have been reduced from 14 to 11 and there is some new clarification and guidance.  The changes, effective July 1, 2012, include:

Combining Object s 8 & 10:  Promote and ensure that hospital processes, equipment, communication and data interoperability facilitate the collection and distribution of consistent and accurate information with local and state partners during an incident or event

Combining Objectives 11 & 12:  Manage all emergency incidents, exercises, and preplanned (recurring/special) events with consistent application of ICS organizational strucutres, doctrine, processes and procedures.

Combining Objectives 13 & 14:  Adopt the principle of Public Information, facilitated by the use of the Joint Information System (JIS) and Joint Information Center (JIC) ensuring that Public Information procedures and processes gather, verify, coordinate and disseminate information during an incident or event.

Revised guidance for personnel requiring NIMS related training (reduced emphasis on IS 800 for hosptial staff and clarification of staff needing IS 100, 200 and 700) Note:  From reading the Implemention Guidance I'm not reallying seeing a reduced emphasis on IS800.  I'll follow-up on this one and report back.

Each of the 11 objectives are important, because compliance is a condition to receive Federal Preparedness Assistance, such as receipt of funds from the Hospital Preparedness Program.  These funds are to be used to maintain, refine and enhance healthcare organization capabilities, as well as, exercising and improving preparedness plans for all hazards.

In addition, compliance with NIMS is also required for receipt of some FEMA funds after a declared disaster has impacted a healthcare organization.

I'm preparing to audit several hospitals in 2012 for compliance with the NIMS Objectives and welcome you to contact me if I can do the same for you.  Write to Christina {at} cthielst {dot} com.

 

 

Telehealth, the Cloud and BI — oh my!

My guest blog post for Health IT Exchange made it onto their list of top 7 community blogs of 2011. Telehealth, the cloud and BI — oh my! includes my post on the importance of connecting health IT with disaster planning and others addressing some of my favorite topics - telehealth, meaningful use, health information exchange, the cloud and medical devices.  

Their list of top 2011 blogs also also includes something new for me - voice commands on mobile devices. I've been watching my teenage daughter, who has a form of dyslexia, speak into her new phone (Christmas present) to text her friends.  It has gotten me thinking... 

To all of my readers, I wish you a very happy and healthy new year!

Earthquake Publications for Businesses

Thousands of earthquakes occur in the United States each year; most are too small to significantly affect businesses and communities. However, large and very damaging earthquakes have occurred in the past and could happen again at anytime.  In general, many businesses (and healthcare providers) have invested in emergency management and continuity of operations planning. However, most businesses have not conducted earthquake mitigation measures to protect their assets, staff, and business operations. During an earthquake, buildings—or their components or contents—can be collapsed, toppled, broken apart, tossed around, or rendered inoperable or unusable.

Therefore, as part of addressing all-hazards emergency management, it is critical for businesses (and healthcare providers) to also incorporate actionable earthquake mitigation solutions into their planning and business decisions.  By doing so, businesses protect the organization’s assets (people, property, operations); sustain the capability to provide goods and/or services to the community; maintain cash flow; preserve competitive advantage and reputation; and provide the ability to meet legal, regulatory, financial and contractual obligations.

To help businesses (and even healthcare providers), the Federal Emergency Management Agency (FEMA) National Earthquake Hazards Reduction Program (NEHRP) has released FEMA P-811 CD:  Earthquake Publications for Businesses (QuakeSmart Toolkit). 

This QuakeSmart Toolkit (FEMA P-811CD) provides business owners, managers, and employees with basic guidance and ready-to-use tools that can be tailored to the specific needs and requirements of the user. The guidance and tools focus on the importance of earthquake mitigation and the simple things they can do to reduce the potential of earthquake damages, injuries, and financial losses at work…AND also at home and within their communities.

The toolkit walks you through the following 3-step QuakeSmart process: 

1. How to identify your risk
2. How to make a mitigation project plan
3. How to take action and implement the techniques for ensuring and enhancing business resilience from an earthquake

These resources are especially timely for California, because the 2012 Statewide Medical and Health Training and Exercise will be an earthquake scenario.  View or download the QuakeSmart Toolkit (FEMA P-811CD) or order CD copies of the QuakeSmart Toolkit from the FEMA Publications Warehouse by calling (800) 480-2520. Or fax your request to (240) 699-0525.  All orders will be shipped in January 2012.

Other FEMA materials and earthquake guidance are also available.

When Agnes' stroke hit, acting FAST saved her life

My work with the Telestroke Initiative has given me an opportunity to learn a great deal about stroke care and to know some of the people at the National Stroke Association.  In the process, I've also heard about some stories that hit really close to home (in the hospital).

One is of Agnes, a stroke unit nurse manager, who on February 10, 2009 went from being the stroke nurse to a stroke patient without warning.  She is a 35-year nursing veteran and a key nursing advocate and partner in establishing the hospital's stroke unit.  Her stroke occurred while relieving one of her nurses for meal break in her hospital's stroke unit.

In honor of each of my friends who care for stroke patients, I want to share the warning signs of stroke with my readers.

 

Apps for Flu Season

Flu season is upon us so it is a good time for me to remind my readers to get those flu shots. Some of you may also be interested in Appitalism’s list of recommended apps:

Medscape

Medscape from WebMD is the leading medical resource most used by patients, physicians and medical students for crucial and update information. The home screen features a search function, medical news, sections for Drugs, Diseases & Conditions, Clinical Procedures, a drug Interaction Checker, and a bottom bar with more functions.

 

iPharmacy Pro

iPharmacy is packed with many features, and it is a handy medication guide, drug reference, or drug guide. The drug information available include indications & usage, dosage & administration, contraindications, warnings & precautions, adverse reactions, contraindications, drug interactions, and over-dosage

 

Dosecast

Dosecast is the most flexible and easy-to-use app for the iPhone and iPad to help you remember to take your medications and vitamins. Simply enter basic information about each drug you take, such as the name, dosage, and how and when you take each drug. You can setup reminders on a daily, weekly, or monthly schedule – or, unlike other apps, for a pre-set number of hours or days after the last dose.

 

iTriage

This app was created by two ER docs, iTriage helps you answer the questions: “What medical condition could I have?” and “Where should I go for treatment?” It also lets you save, easily access, and share the healthcare information most important to you.

 

If you have tried any of these apps, leave a comment and let us know what you think!

Hospital CEO Sees the Impact of Telestroke Firsthand

This is a great story for all of my hospital administrator friends who are still trying to understand the value of telemedicine and telestroke services.

While attending a meeting for the Colorado Hospital Association in Vail, CO, Mr. Brad Cochenennet, CEO of Pagosa Springs Medical Center, began to experience stroke-like symptoms. Mr. Cochenennet was rushed to Vail Valley Medical Center, a 58-bed facility in the heart of the Rocky Mountains. Once there, the attending physicians determined that Mr. Cochennet required an immediate examination from an expert neurologist. At this point, Dr. Chris Fanale, a neurologist at Swedish Medical Center in Englewood, "beamed in" to conduct a stroke assessment of Mr. Cochenennet's condition via an RP-Lite.

 

Coincidentally, the doctor and patient had met before under very different circumstances. Dr. Fanale and Mr. Cochennet had previously worked together to bring a telemedicine system to Pagosa Springs Medical Center. Mr. Cochennet now has firsthand experience of how telestrok systems can have a crucial impact in saving lives. Thankfully, Mr. Cochennet made a speedy recovery and was shortly released from the hospital.

View the complete NBC 9 News video coverage of the story and learn more about telestroke at the telestroke Initiative site.

 

The Other Defensive Medicine... Security!

Two months ago I participated in a program on hospital safety and security and earlier this week I was interviewed for an article on the same subject.   It is amazing how seemingly random things can string together.  

I hope you enjoy this cartoon about the other defensive medicine... a reality of modern healthcare.  It only starts with security in the emergency room!

                           By Modern Healthcare

 

A Culture of Safety in Hospitals and the CEO's Role

I prepared a handout for a recent HCESoCal educational/networking event and I'm sharing it here, because I really believe it is important for truly effective healthcare leaders.  

Quality and safety do rise out of the culture of the organization and ownership for creating it is the responsibility of the leadership team.  But, the CEO's desk is where the buck stops.  And, the governing body is reponsible for the oversight to ensure that the roles and responsiblities are carried out in accordance with their policy.

Core Organizational Infrastructure Components[i]

 A Culture of Safety

• Plans for Managing Risks and Maintaining a Safe and Secure Environment of Care (Hazardous Materials/Waste, Fire, Medical Equipment, Medical Gases, Utility Systems, etc)
• Collecting Information, Monitoring Conditions, Analyzing Issues and Improving the Environment of Care
• Integrated Patient Safety Program (National Patient Safety Goals, Staff Competency, Infection Control, etc)
• Emergency Management (Hazard Vulnerability Analysis, Emergency Operations Plan, Communications, Managing Resources/Security/Safety/Staff/Patients/ Volunteers/Utilities, &Testing/Exercises)
• Life Safety
• Communication (Between leaders and to those who need it, including staff, licensed independent practitioners, patients, families and external interested parties.)

The Healthcare Executive’s Role[ii]

Guide an organizational culture dedicated to improvement, focusing resources on the structures, processes and monitoring systems that will ensure patients receive the care they need without risk of harm.

Equip board with tools and information to provide appropriate oversight of the patient safety/quality strategy

• Involve the entire executive leadership team in the patient safety/quality strategy
• Engage the medical staff as meaningful partners in the development and implementation of the patient safety/quality strategy
• Develop processes to hear the voices of patients and families and applying their input in the design and improvement of care processes.
• Cascading a patient safety/quality orientation throughout the organization
• Develop a culture of improvement that includes an organization-wide commitment to continuous learning.
• Rigorously seek out and apply best practices.
• Provide open communication and demonstrate a commitment to transparency
• Adopt information systems that support the patient safety/quality strategy
• Encourage organizational involvement in voluntary collaborative

 [i] Joint Commission 2011 Acute Care Standards, Revised December 2010.

 [ii] The Healthcare Executive’s Role in Ensuring Quality and Patient Safety, ACHE Policy Statement, November 2008.

 

Feel free to download the actual Healthcare Safety Program Handout. 

Also check out the article The Patient Safety Team: Healthcare Executives Embrace Their Role, which highlights the impact that transparency is having on moving safety to the front burner. 

NOLA Medical Surge

I spend a fair amount of time thinking about medical surge in Santa Barbara County, so I can't help but notice what other communities are doing when it comes to disaster planning and response.  

A game at the Superdome is certainly a good reason to bring out this medical surge unit and they are supported by at least 10 EMS/triage stations inside and outside of the dome.  NOLA does experience a high number of alcohol/drug related hospitalizations and I can only image how many occur in and around football games.  In addition, there are always routine emergency needs and the risks associated with a large number of people in an enclosed space.

If you like this kind of stuff, check out my post from this past summer that highlights the USS Midway's Hospital.

Preventing Surgical Fires

The U.S. Department of Health and Human Services’ Food and Drug Administration (FDA) and its partners have launched an initiative and website to increase awareness of factors that contribute to surgical fires, to disseminate surgical fire prevention tools, and to promote the adoption of risk reduction practices throughout the health care community. Resources and tools  available for hospitals, surgery centers and other providers include posters, checklists, educational videos and information for patients.

Physicians and HICS

Here is a nice blending of two of my worlds. This YouTube video (social media) is a great training tool for physicians who may be called upon to fill a hospital incident command system (HICS) role (disaster preparedness & response), such as, the medical/technical specialists.  If you experience challenges getting your physicians to your hospital's training, or just want a different tool to reinforce of key points, consider this video.

 

Thanks Stanford Hospital and Clinics and Lucile Packard Children's Hospital!

 

Critical Care 24/7

I've been fortunate to have learned so much about telemedicine over the last several months and see value in its application in multiple healthcare settings.  Health Management Technology invited me to share my thoughts on the subject of telemedicine and I chose to highlight the value with two high volume and potentially high cost conditions - sepsis and stroke.

Critical Care 24/7  will hopefully spark interest thought in by healthcare leaders who may be challenged with these patients.  

Thank you Dr. Rogove for helping me to understand the value of staff access to intensivists via telemedicine for more aggressive treatment of sepsis.

eMagazine version.

Social Media in Disasters

September is Disaster Preparedness Month so I'm especially happy to share the new Congressional Research Service report titled Social Media and Disasters: Current Uses, Future Options, and Policy Considerations.  It isn't limited to healthcare, but the information is still relevant.

They see social media it being used in disasters in two broad categories - passively to disseminate info and receive feedback and systematically as an emergency management tool. The latter goes further than the former by:

• using the medium to conduct emergency communications and issue warnings
• using social media to receive victim requests for assistance
• monitoring user activities and postings to establish situational awareness 
• using uploaded images to create damage estimates, etc.

As with everything, there are risks.  My recommendation is to trust who you follow, confirm information whenever possible and pay close attention to details of the tweet, such as, the time sent, if it is a re-tweet and the original sender.

A new Modern Healthcare article on Staying Connected may also be helpful.

I encourage all of my readers to make a plan and be prepared at home and work.  Visit the Ready.Gov site for helpful information and resources!

 

Emergency Water Supply Planning

Preparations for the CA Statewide Medical Health Exercise are underway and today includes an American Water Works Association (AWWA)  web program on Planning for an Emergency Drinking Water Supply and Emergency Water Supply Planning for Hospitals and Health Care Facilities.   If you missed it the presentation slides are available for downloading.

A guide is also available at  Emergency Water Supply Planning for Hospitals and Health Care Facilities and there are resources on the CDC's healthy water site.

Also, since we are on the subject of disaster planning some of my readers may be interested in Carl Taylor's “Random To Do To List For Hurricane Irene”.  Carl lives and works in Alabama and shares his wisdom with those on the East Coast.

1135 Waivers and Hospital Evacuation

I completed two evacuation tabletop exercises this month and also have started the review process of our plan template.  At the same time I learned about a great educational resource from FEMA & the American College of Emergency Physicians for administrators, anyone with a HICS leadership position and hospital emergency planners. Hospital Evacuation:  Principles and Practices 

This presentation reminded me of a recent hospital evacuation (Joplin, MO) that included a 1135 Waiver, which is important as an organization begins to consider recovery and re-entry.  

What is a 1135 Waiver?  

When a disaster or emergency is declared, the HHS Secretary may temporarily waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled.  In the case of Joplin, MO, the 1135 waiver allows Freeman Health System to temporarily expand their number of beds in the community to accomodate patient demand until the St. John's Medical Center can be re-built.  The result is that between the three Freeman hospitals in the area, 147-beds will be added to accommodate patient demand in the community.

 

 

Louisiana State Medical Society: Healthcare and Disaster Planning

I just learned about a resource on disaster planning for healthcare, a project of the Louisiana State Medical Society, and want to share it with my readers.  I've only quickly reviewed the 122-pages, but notice it has some great pictures to give readers a real perspective on the issues discussed.  I also noticed one chapter includes a section on leadership and organization effectiveness (one of my favorite topics), so I can wait to read this one.

Here in Santa Barbara County we continue to work on our hospital and public health preparedness and I look forward to learning from and incorporating Louisiana's lessons learned.

Connecting Healthcare IT and Disaster Planning

Mind the Gap is a blog post I wrote specifically for my friends at Health IT Exchange.  I love to combine multiple interests and this one connects my hospital disaster planning and preparedness work with my interest in health information technology.

I'm thinking I might also want to draft the forms I referenced in the article.  Let me know if this would be of value.  Also, stay tuned for an Health IT Exchange chat about this subject.

Healthcare Emergency Codes and Information Technology

I'm not really sure what is happening, but I seem to have had a surge in emergency and disaster posts.  I also just submitted an article that will be published soon on disaster planning for information services and technology departments.

Today I'm sharing a resource that I often wondered about when I worked in my hospitals. Healthcare Emergency Codes:  A Guide for  Code Standardization is an effort to standardize codes across hospitals so that there is consistency given that our staff usually move across facilities.  In healthcare and disasters, standardization is wonderful whenever possible.  The standard codes for hospitals are:

RED for fire Š

BLUE for adult medical emergency Š

WHITE for pediatric medical emergency Š

PINK for infant abduction Š

PURPLE for child abduction Š

YELLOW for bomb threat Š

GRAY for a combative person Š

SILVER for a person with a weapon and/or hostage situation Š

ORANGE for a hazardous material spill/release Š

GREEN Patient Elopement

TRIAGE INTERNAL for ALERT internal disaster  Š

TRIAGE EXTERNAL for ALERT external disaster

Many hospitals are also starting to call codes for bed capacity to speed patient flow and avoid the need for diversion.  At some point, we may see an attempt to standardize this one.

Information technology is increasingly becoming a critical tool to business and clinical functions.  So, having just written the HIT disaster paper, I'm wondering if there should be some sort of information code.  For example, if malware or a virus is identified should a code be called to alert users to not use a particular system or to be cautious of suspicious emails.  In the past I would receive an email, but how many did I open before I got to that one.

Since I'm not a techie, I'm wondering what my techie readers think.  Can you see an information technology event that would warrant alerting electronic information users by calling a code?  Lets think and post this through and see what we can come up with together.

Integrating Social Media into Emergency-Preparedness Efforts

The NEJM includes an article that addresses the integration of social media in emergency preparedness efforts from the perspective of physicians.  I appreciate the examples they share and agree with the authors.  Key issues include:

• The effectiveness of our public health emergency system relies on routine attention to ppreparedness, agility in responding to daily stresses and catastrophes, and the resilience that promotes rapid recovery. Social media can influence each of these component efforts.
• Medical providers do need communities who are prepared for their role in a response and integrating social media into local activities could help build social capital and community resilience.
• GPS software used in some social media (Four Square) can facilitate "check in" and reporting of conditions in the individual's immediate surroundings. 
• Social media cannot and should not supersede current approaches to disaster management communication or replace public health infrastructures, but if leveraged strategically, they can be used to bolster current systems
• Social media might well enhance our systems of communication, thereby substantially increasing our ability to prepare for, respond to, and recover from events that threaten the public's health.