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12/9/2012 1 0 MARK SOLAZZO Executive Vice President and COO MARK JARRETT , MD Chief Quality Officer RESPONSE TO HURRICANE IRENE NORTH SHORE-LIJ HEALTH SYSTEM Session C26: These presenters have nothing to disclose 1 Objectives Describe the steps necessary to ensure the safety of patients, employees and the community during multiple emergency hospital evacuations Discuss the role of the Emergency Command Center and the vital aspects of ongoing internal and external communication

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Page 1: RESPONSE TO HURRICANE IRENE - IHI Home Pageapp.ihi.org/FacultyDocuments/Events/Event-2206/Presentation-7639/... · 12/9/2012 1 0 MARK SOLAZZO Executive Vice President and COO MARK

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MARK SOLAZZO

Executive Vice President and COO

MARK JARRETT, MDChief Quality Officer

RESPONSE TO

HURRICANE IRENENORTH SHORE-LIJ HEALTH SYSTEM

Session C26: These presenters have nothing to disclose

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Objectives

� Describe the steps necessary to ensure the safety of patients,

employees and the community during multiple emergency

hospital evacuations

� Discuss the role of the Emergency Command Center and the

vital aspects of ongoing internal and external communication

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� System Administration is notified of an increasingly high probability of a

hurricane landfall on Long Island

� System Administration authorizes that an advisory notice be sent to all

employees

� Public Safety’s Emergency Management

Division establishes conference calls with all

critical infrastructure divisions

� Emergency Management briefs the following

entities:

� Executive Directors

� Department Heads of Materials

Management, IT & Telecommunications,

Facilities & Engineering, Risk Management

� All departments are to begin activating

emergency plans

Early Warning & PlanningTuesday, 8.23.11 – 0800 Hours

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96 Hours to Landfall: Actions BeginWednesday, 8.24.11 - 0800 Hours

� 24/7 surveillance of weather & hurricane

� 4-hour weather updates are issued

� Critical infrastructure departments are

briefed twice daily

� Hospital evacuations are under evaluation

� Emergency purchasing and leasing begins

� System Administration places the Health

System on a Level 1 HICS

� Health System EOC is opened

� Rapid discharge and surge plans are under

review

� Employees advisories are upgraded to alerts

� Employees are advised to begin personal

readiness actions

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72 Hours to LandfallThursday, 8.25.11 – 0800 Hours

� HICs Level 2 is ordered and all weather reports are confirming a L.I. - NYC

landfall

� Evacuations appear likely to occur at SIUH North and South sites

� All critical infrastructure needs and requests are being filled

� All municipal emergency management

agencies are consulted

� EOC initiates 24/7 staffing model

� Facilities leadership orders a stop work order

on all construction sites

� All sites are to be secured within 24 hrs

� Union labor issues are considered

� Vendors and contractors are asked to provide

their staffing models

� Employee alerts are increased to twiceper day

� Executive conference calls occur every 4 hrs4

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48 Hours to LandfallFriday, 8.26.11

� Decision has been made to evacuate SIUH North & South and begin

evacuating Southside Hospital, as well

� Emergency purchases begin to arrive at system hospitals and

Emergency Management Headquarters in Syosset

� Emergency generators are disbursed based

on assessments by facilities and

engineering leadership

� Hospitals are asked to prepare staffing

models and submit them to Emergency

Management

� Hospitals are instructed to begin rapid

discharges and surge plans are to be

activated

� Executive leadership have suspended all

elective surgeries through Tuesday6

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� Final checks are being made with all system partners at our sites

� All equipment requested by the sites have been delivered

� A decision has been made to evacuate

Southside Hospital

� Many nursing homes are seeking assistance

in evacuations as well as area hospitals

� NS-LIJ staff is sent to these facilities to

coordinate, evaluate and facilitate

evacuations and/or sheltering

24 - 36 Hours to Landfall

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� SIUH evacuations are completed

� Resources had been shifted east earlier as the need declined in Staten Island

� Southside evacuations completed

� NSHS begins to take additional evacuees from

nursing homes in Nassau and Queens

� NSHS coordinates additional evacuations in

Rockaway and to sites outside the Health

System

� NSHS begins to take patients who refuse

special needs sheltering

� Patient tracking and patient medical

evaluations are the primary operations sector

duties

12 Hours Out

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During the Storm

� All transportation services and deliveries are suspended

� Facility damage assessments are conducted regularly

� Monitoring of utilities is constant, many facilities go to generator

power

� Staff attendance shows no significant absentee rates

� No facilities are closed to emergencies, including the evacuated

facilities

� Patients continue to arrive in Emergency Departments

� All NSHS Hospitals are reporting “normal” operations

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Post Storm

� There are no patient deaths that are the result of the storm

� The NSLIJ health system:

– Evacuated 947 patients

– Accepted an additional 245 evacuated patients from non-health

system facilities

� Risk management and Finance have been dedicating time to

recovery efforts including FEMA reimbursements and insurance

claims

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Summary

� 947 patients were evacuated from Southside Hospital and Staten

Island University Hospital

� All evacuated inpatients were safely transported prior to the storm

� Southside Hospital and SIUH and both continued to keep their

Emergency Departments open throughout the storm

� Post storm, all of the evacuated patients were safely discharged or

transported back to their original facility depending on their medical

condition

� 70 nursing home patients from seven different facilities in the

Rockaways and Long Beach were accommodated at:

– North Shore University Hospital’s Stern Center for Extended Care and

Rehabilitation in Manhasset

– Long Island Jewish Medical Center

– Franklin Hospital

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Summary (cont’d.)

� Nassau University Medical Center also accepted many patients from

Long Beach Medical Center, which was also evacuated.

� North Shore-LIJ ambulances assisted Saturday evening with the

transport of 125 patients from city nursing homes to Park Slope Armory

and New York Methodist Hospital in Brooklyn, and Metropolitan

Hospital Center in Manhattan. This was at the request of New York

State Health Commissioner Nirav Shah, MD, and the New York City

Office of Emergency Management

� In addition, numerous individuals who lost power in their homes

showed up during the storm at North Shore-LIJ hospitals seeking

shelter from Hurricane Irene.

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Summary (cont’d.)

Opportunities

� Train additional NS-LIJ staff as adjunct faculty to the Emergency

Operations Center

� NS-LIJ will continue to expand our “Ready -Set –Go” emergency

preparedness initiative

� Continue to enhance employee communications

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Planning and Preparation

Effective Strategies/Best Practices

� Early planning sessions and conference calls allowed time for

leadership to make critical decisions.

� Mandatory TQLT meeting on Thursday proved effective in getting

management focused on task at hand.

� Early assessment of facility vulnerabilities helped to visualize the

threat to the hospitals.

� Early assessment of resources allowed time to increase par levels

where indicated.

� Transfer of NICU patients immediately following evacuation order

allowed for their safe and orderly transfer with and to the

appropriate level of care.

� Implementation of HR Emergency Situation & Inclement Weather

Policy effectively ensured adequate staffing levels.

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Planning and Preparation (cont’d.)

Opportunities for Improvement

� Existing forms used to categorize patients’ transportation needs,

demographic information, and evacuation information proved

difficult to work with

– Patient Care Units Managers were provided the next day with a

more user-friendly form adapted from GNYHA

Recommendations

� Improve the status reporting form in the Evacuation Plan using the

adapted GNYHA format as a guide

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Stay Teams

� To address concerns that area residents may seek shelter and

medical care during the storm, Stay Teams were expanded to include

sufficient clinical staff to provide patient care, if needed

� Staffing plans were developed for

the following to cover through

Sunday night

� Dietary, sleeping, and parking

arrangements were made to

accommodate staff

Evacuation Processes

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Evacuation Processes (cont’d.)

Effective Strategies/Best Practices

� Coordinated effectively with the System to secure appropriate beds

and transportation for all patients

� Patient relations created an effective chain of communication

between hospital and patient family/friends

� Utilizing social networking, hospital website and HEICS hotline to

communicate scheduling decisions with staff

� Patient safety was maintained throughout the evacuation process

– No patient or staff injuries

� Efficiently distributed four day supply of medication to transferred

patients

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Evacuation Processes (cont’d.)

Effective Strategies/Best Practices

� Having a preexisting agreement (coalition) with other Staten Island

facilities for mutual support in a disaster

� Have expanded Stay Teams in place to provide emergency medical

care for surrounding community

� Provided printed information regarding nearest shelter location and

directions for both North and South sites

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Evacuation Processes (cont’d.)

Opportunities for Improvement

� Gaps in communication in patient transfer process

� Infrequent communication updates with on-duty staff

� No process in place to inform family members that were present

during evacuation

� Improved tracking process for equipment loaned to other facilities

� The Main Conference Room at North Site was not conducive to

implementation of Incident Command System

� Incident Command structure was not fully developed

� Key HEICS roles were not assigned

� No order of succession designated for relief of individuals in key roles

� Better communication with departments about labor pool

use/function

� Better utilize staff support function as described in HEICS structure

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Evacuation Processes (cont’d.)

Recommendations

� Make better use of radio and Spectralink phones to communicate

vertically among all levels of staff

� Better utilize technology to track patients and equipment

� Expedite relocation of Primary EOC to McGinn Education Center

� Incorporate a family reception/information area into the evacuation

plan

� Designate areas for HEICS Sections with communication capabilities

for each section

� Develop the role of EOC Manager to coach the Command staff during

plan activations

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Evacuation Processes (cont’d.)

Recommendations

� Resume ongoing education on the incident command structure for

hospital leadership

� Provide more frequent communication updates with on-duty staff

� Provide education to unit staff regarding evacuation triage and

transport needs

� Establish mechanism to assign physician and PCUM teams to

expedite evacuation process

� Train staff on new processes and evaluate effectiveness in an exercise

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Recovery

Effective Strategies/Best Practices

� Coordinated effectively with the System to quickly verify building

integrity and resume occupancy

� Department and unit management communicated needs to aid in

return to normal operations

� Patient repatriation process considered factors including patient

condition and family needs and availability of proper level of care

� Patient repatriation process took into account patient needs, family

requests, and availability of services at receiving facilities

� Setting priority order of re-opening departments and resuming

services

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Opportunities for Improvement

� Information regarding transferred patients was not easily accessible

� Equipment tracking and retrieval process could be better

coordinated

Recommendations

� Develop an evacuation database and improve Series application to

populate this data base as patients are transferred

� Create process for identifying and tracking equipment as it is loaned

to other facilities

Recovery (cont’d.)

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