“Our biggest challenge in Houston was the staff, the people who were affected by the storm,” Wargo says. “Through HealthTrust Workforce Solutions, Parallon Business Solutions, as well as HCA Healthcare’s Clinical Services and Physician Services Groups we managed the relief staff part of the equation very well. But the community infrastructure there is going to take a long time to recover. That has meant not just our employees and our facilities, but also dealing with the demand on healthcare that rose as people came back home. For instance, many evacuees didn’t take their medications with them — they were healthy when they left, but they came back sick. Many other systems were still closed, and HCA Healthcare was open, so we saw increases of 120 percent to 160 percent in our emergency rooms. It was almost a secondary disaster.”
There, as in Florida, volunteers who were not involved in patient care manned information tables and visited every hospital department to help employees understand how to access EAP and other HR services, as well as apply for Hope Fund support.
The Learning Curve Begins
The relief had two key components, both focused on helping affected employees and providing seamless patient care. One was deploying personnel, and the second meant moving to downtime analog systems when a hospital’s electronic systems were offline. For instance, vital needs such as medication delivery required not just forms, but runners to get prescriptions from the pharmacy to the patient floors.
“There are a lot of interdependencies in patient care, and all that was going toward downtime or paper operations,” Wargo says. “The automation was gone, at least for a short while, and the challenge was to move to paper operations without interrupting patient care. Our people did that because the plans were in place, but we also saw some amazing innovations because people got creative. We’re going to work to capture that, so we can prepare even better for the next emergency.”
Scalability will be the key metric in that process. Many on-the-ground innovations from the storms and other recent events have Wargo and many others excited already.
“We have a very sophisticated paper form for evacuations, and nurses were consulting it every few hours,” he explains. “It tells us which patients are the priorities at any given time. That evolved from a lightning strike at Bayonet Point Regional Medical Center last year, when they had to do a no-notice evacuation. They created a system where every four hours a manual census was printed, so they could verify the patients who were in-house, and so the nursing supervisor could provide an updated form to every shift. From that came a log of what patients charge nurses were rounding on, which cases were more critical and team notes. That has led to a system where we know how many critical care or air transports we need, and who has to leave first. As those patients go, they are de-listed and everyone knows they are out of harm’s way.”
In the operations center, emergency response has morphed into a “hot wash,” a military term that describes a process that assesses what was done well — and what needs immediate follow-up action.
“The next storm could be a week away, so we need to be immediate,” Wargo says. “We began with our five main areas: clinical, infrastructure, support, administrative and intelligence. We are learning what we can do differently that will improve the next response, or our resilience. We will share those best practices so that all our facilities can learn and adapt quickly.”