This past spring, several areas of the United States were impacted by the outbreak of H1N1, also known as Swine Flu. Over a short period, what began as a punch line turned into a serious concern for hospital leaders, as emergency rooms filled up with worried patients and administrative staffs were flooded with phone calls. Hospitals in several states were forced to set up tents and convert conference rooms into screening areas to accommodate the sick.
While the H1N1 outbreak never quite reached the threat level some predicted, it did provide organizations with a golden opportunity to assess their preparedness should an infectious disease turn into an epidemic.
At Massachusetts General Hospital (MGH), a member of the Boston-based Partners HealthCare network, leader ship wasted no time putting a plan into action. According to CIO Jim Noga, the 902-bed hospital quickly activated its Centralized Ambulatory Screening and Treatment (CAST) plan, which entailed setting up a high-volume screening clinic and developing EMR templates based on criteria from the Centers for Disease Control and Prevention (CDC) in Atlanta.
The two-pronged approach had been developed after the SARS outbreak of 2006 to ensure the facility was prepared to handle another event of that kind, says Noga. The primary goal was to ease the burden on the emergency and administrative departments by designating other locations for patient screenings.
Another key piece of the plan was educating the public. According to Noga, a link was posted on MGH's homepage providing resources on H1N1, hand-washing tips and information for patients about what the organization was doing to prepare and protect against the virus. “It explained how we were communicating internally so they could see what we were doing to make sure our staff had the most correct and current information. Transparency is very important in these situations,” says Noga. “We wanted to provide a reliable source of information, because unfortunately, in the media, there's often a lot of misinformation.”
The marketing and infectious disease departments at MGH collaborated to develop the content for the site, which was posted in a matter of days. Although some IT support was required, Noga says it wasn't a great deal. “I see IT as the enabler of supporting the infectious disease department rather than driving the communication, and that's what happened in this case,” he says.
MGH also created a SharePoint (Microsoft) site where providers could find status updates and access documents containing treatment and action steps. In addition, the IT team created templates incorporating the CDC's H1N1 screening criteria for the EMR system, which was developed in-house. This way, says Noga, clinicians could make sure they were asking the right questions and documenting data properly during the screening and treatment processes.
Overall, Noga says he was pleased with his facility's response to the outbreak, noting that “having a plan in advance and knowing who is responsible and accountable for each step and task” is critical, along with conducting tests on a frequent basis. “Fortunately, it didn't turn out to be as severe as people anticipated, but it was a good run for us to really test all our processes and procedures,” he says.
Rolling out beds
At two-hospital KishHealth System in DeKalb, Ill., the most critical piece of the H1N1 response was communication. When the outbreak started to escalate, KishHealth's leadership team met with representatives from the infection control, nursing and emergency departments to identify what the next steps should be. “This happened before we had any confirmed cases in Illinois,” says Vice President and CIO Health Bell. “I think we were being very proactive in that regard.”
The first step? KishHealth needed to increase its bed capacity, and quickly. “One of our initial fears was that if we ended up with an outbreak or at least a confirmed case, we would see an influx of patients, if nothing else, just wanting to be tested,” says Bell.
So KishHealth turned to its ED tracking system, a homegrown tool that displays bed status and has helped improve patient flow at Kishwaukee Community Hospital, according to Bell. He and his team modified the system to display not just the beds - and rooms - that were available, but also the triage areas designated to house patients during an emergency situation. For example, Kishwaukee had a quiet room in its ED that was converted into an exam room. Plans were also made to set up an outside tent that could hold an additional 25 beds for screening. If occupied, those beds were displayed on the tracking board using a separate code, says Bell.
“We've actually incorporated a disaster tab into our system, so an administrator like our ED director or one of my IT staff members can, at a moment's notice, activate that and expand our bed capacity in the ED from 15 beds to essentially 40 beds in a matter of seconds,” he says.
The tracking system is also equipped to display potential flu cases, which can provide clinicians with even more visibility during critical situations. “It allows the physicians to understand that, for example, we don't just have 10 people in the waiting room. We have 10 people in the waiting room that have flu-like symptoms that are going to need to be addressed, and we're now going to have to call in a lot of extra help. So it helped in making management decisions,” says Bell.
Because there were procedures in place, KishHealth was able to take the necessary steps, not just to accommodate a higher number of patients, but also educate the public through its Web site. Adds Bell, “Every situation, unfortunately, in healthcare disasters is a little bit different, and you do the best that you can to prepare for them. And then you rely on your expertise in the heat of the moment and make the changes necessary to react in the best way possible.”
UPMC's Online Command Center
The site was utilized during the recent H1N1 outbreak to coordinate information for the health system, the region and the state, according to Bill Smith, director of environmental safety and health at UPMC. “What happens most frequently in emergency situations is people don't know the status at any given moment. There's an information lag. The other issue is there are multiple sources of information out there, and they have different systems and different silos,” says Smith. “PrepLink.org was established to synthesize that information and give people a place they can go to for accurate information.”
The site includes public information, such as links to the CDC and status on hospital closings, as well as a secure side for providers. During the various stages of H1N1, staff from UPMC and both the Allegheny County and Pennsylvania state health departments leveraged the secure site to communicate, share documents, and provide situational awareness updates, he says.
“We posted documents in a workspace where everyone with a secure log-in could comment or review to make sure we had the most updated version, as opposed to e-mailing it out to everyone, where you have 30 versions floating around and you don't know which is the most updated,” says Smith. “We eliminated that problem with this tool, where we can have our expert team review a document and we can have it to the physicians very quickly.” - K.G.