Preparing for Disaster

On the Ready
Disaster preparedness is no longer optional.

New York University’s (NYU) Downtown Manhattan Hospital was one of many victims of the Sept. 11 terrorist attacks. The hospital is just blocks from the site of the World Trade Center and was a primary care site on that tragic day. In fact, it was overwhelmed with too many victims to count. On a typical day, the hospital treats about 100 people. After the terrorist attacks, hospital officials estimate that doctors and nurses treated more than 1,200 casualties.

The hospital lost $32 million as a result of that day, Healthcare IT News reported. The chaos of the moment, and an inadequate system to manage the colossal surge in patients, resulted in details Ð important details Ð slipping through the cracks. Officials from NYU Downtown estimate they registered and tracked only about 10 percent of the patients who came for emergency treatment that day. Because of the lack of adequate records, the hospital had no means to obtain reimbursement for much of the cost.

Today, less reason exists for a hospital or IDN such as NYU Downtown to suffer such a severe financial blow due to inadequate disaster management systems. Using expert systems, decision-makers can now take action with improved efficiency and results. An expert system is intuitive software that, based on best practices, serves as a guide and recorder during a crisis. Such systems can recommend responses and capture, analyze and track relevant data so important steps are not overlooked.

Wake-up call
Sept. 11 was a wake-up call for the healthcare industry. It underscored the necessity of disaster management plans, which can help hospitals and IDNs function in the most extreme circumstances and leave them financially solvent in the aftermath. Such circumstances include terrorist attacks; man-made disasters such as Three Mile Island; and natural disasters. Even an event like the Great Blackout of August 2003, during which much of the East Coast lost power, can cause incalculable problems. Disaster management plans can help providers cope with incidents that directly affect their fabrics, personnel and resident patients.

JCAHO says so
Following Sept. 11, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) designated disaster management one of seven “environments of care.” JCAHO expects hospitals to move beyond disaster management plans to disaster management programs. Providers should have in place programs that are agreed upon, tested and executable, wrote the JCAHO in its 2003 white paper, “Health Care Emergency at the Crossroads: Strategies for Creating and Sustaining Community-Wide Emergency Preparedness Systems.” According to JCAHO, “There is a fundamental need for templates and scalable models for community-wide preparedness to guide planning before, and actions taken during and after, an emergency.”

JCAHO also has insisted that providers make care for caregivers a high priority. That means providing things such as personal protective equipment, vaccinations, prophylactic antibiotics, chemical antidotes and counseling. What’s more, JCAHO insists that caregivers be able to attend to their families’ concerns, including two-way information on their statuses and that of their family members.

It is fascinating to note that 62 percent of the emergency department nurses at St. Vincent’s Medical Center, the hospital at the center of the Sept. 11 medical response, had spouses or partners who were first responders. What could this mean? The sociological and psychological risk to communities from a mass casualty event may be highly concentrated among a hospital’s staff.

Expert systems and disaster management
Hospital administrators and employees must embrace and practice disaster management programs, so the programs will be reliable during the galloping, intense tempo of real crises. This preparation starts with day-to-day management of patient surges. If hospitals can refine surge management processes when patient surges are slight instead of drastic, they will be that much better prepared when a major disaster strikes. In addition, effective surge management is financially beneficial. An emergency room that can take in a few more patients than available beds without lessening the standard of care will generate additional revenue, preserve its reputation and gain referrals. Effective surge management also means fewer resources, including staff time, are unnecessarily consumed.

Expert systems can provide solutions for surge management and disaster management preparedness. Broadly speaking, an expert system is a type of software that mimics how the human brain locates, assesses and deploys knowledge. It also finds solutions. Imagine digitalizing the knowledge and experience of all the best people in the healthcare industry, then making it accessible without limit in time or place, and tailoring it to specific circumstances. That, in essence, is an expert system. Moreover, with the ability to capture the know-how of the best domain experts, hospitals can mitigate the effects of the “brain drain” that often occurs when experts retire or, worse, join a competitor.

The hospital should have access to an expert system in the form of a digital mentor before, during and after an incident. The system would replicate the ability to understand context, mental frameworks, logic, rules of thumb and problem-solving processes that a “live” expert would bring to a task. It would help the hospital adapt to the particular circumstances of a specific incident. Accessibility and flexibility are the watchwords. Expert systems are now accessible via the Internet 24 hours a day from any location.

Expert systems in action
Prior to an incident, the expert system can provide an assessment of a hospital’s or IDN’s state of readiness, help generate a disaster management plan, and support disaster management training.

During a crisis, the expert system guides decision-makers through the process of setting up an incident command center, evaluating the situation assessment and response, issuing job action sheets, identifying treatment protocols, and managing crisis communications, all while tracking patient flow, costs and process effectiveness. Finally, after the disaster, the expert system captures the lessons learned and identifies remediation opportunities.

The same expert systems that guide decision-makers through disaster management situations can also help them streamline day-to-day operations. Managing supply levels, identifying supply-and-labor inefficiencies, and meeting accreditation requirements are just a few of the everyday applications of today’s more advanced expert systems.

The expense of an expert system depends on how many facilities share it. The annual cost may be in the low-four figures for smaller hospitals and mid- five figures for large metropolitan institutions. Of course, better surge management will also increase revenues and decrease expenses. Ultimately, the return depends on the number and nature of incidents a hospital incurs.

The right expert systems can help preserve your hospital’s or IDN’s reputation and level of patient care, both on ordinary days and extraordinary days. The pressures hospitals face, especially the inevitability of future disasters and from the JCAHO in response to that prospect, dictate that providers integrate effective disaster management programs.

Like NYU, communities depend on local hospitals during the most desperate moments. It is imperative that providers be prepared.

About the Author
Paul Dimitruk is the founder and CEO of PortBlue Corp. (paul.dimitruk@portblue.com). PortBlue develops and hosts expert systems for the healthcare and national security industries.

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