If disaster strikes, is your practice prepared?

Hurricanes and wildfires may have claimed recent headlines, but natural and other disasters that can devastate physicians’ practices, hospitals, and entire regions take many forms-from blizzards, earthquakes, floods, and fires, to terrorist attacks, explosions, epidemics, and data breaches.

In essence, no one (and no practice) is immune.

A month after Hurricane Harvey’s aftermath, Houston-based urologist Steven Canfield, MD, says his practice is still having to reschedule operating room times to help out with the hurricane-induced OR shortage.

Dr. Canfield, chief of urology at Memorial Hermann-Texas Medical Center in Houston, says Houston medical centers and medical schools had learned their lessons about hurricane preparedness after severe flooding from Tropical Storm Allison in 2001. Texas Medical Center, for example, has since installed a flood gate network, above-ground electrical vaults and generators, and water pump systems to protect its infrastructure.

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Dr. CanfieldBut while the preparation and timely implementation of storm surge protections kept the University of Texas (UT) Health Science Center and Texas Medical Center from severe flooding, Harris Health System’s two flagship hospitals and community practices in Houston were impacted. As a result, so were affiliated physicians and patients, says Dr. Canfield.

“Ben Taub Hospital flooded,” Dr. Canfield said. “LBJ General Hospital, where the UT Medical School provides coverage and where I also practice, didn’t flood but sustained storm damage-to the point that a number of ORs have been shut down since, and about 100 inpatient rooms have been affected, leading to a mandatory cancellation of elective surgeries requiring postoperative admission.”

Next: Patient triage addresses critical cases

Patient triage addresses critical cases

Dr. Canfield and colleagues have tried to triage cases, so that more critical cancer and other urgent patients are taken care of before patients scheduled for elective surgeries and less urgent cases.

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“Some of those smaller cases, unfortunately, include patients with chronic kidney stones for example, who certainly are suffering but would not be as critical as a cancer patient,” Dr. Canfield said.

Hurricane Irma, which battered South Florida Sept. 10, took its toll on physicians and patients at the University of Miami Health System, including Sylvester Comprehensive Cancer Center in Miami, according to Chad Ritch, MD, a urologist on staff there.

Staff prepared in the week leading up to the storm by trying to make sure that the sickest patients were stabilized and those who could be discharged were sent home or to other facilities, to avoid a critical mass in the hospital during and after the storm, according to Dr. Ritch.

“In our clinics, we had to reschedule a lot of patients who were coming in for procedures while making sure to see the more critical patients before the clinic shut down,” he said.

The health system and clinics shut down Thursday and Friday before the storm, and remained closed Monday and Tuesday after.

“Post-storm, we were set up to have an emergency response team, from each department, in the hospital. So from urology, we had a doctor on call who stayed in the hospital, as well as a resident because we’re a teaching facility,” Dr. Ritch said. “Our team A were the people who stayed in the hospital from the morning of the hurricane to the day after, 7 a.m. to 7 a.m. Then, post-storm, we had our B-team, so to speak, who came in the following day after the storm. Then, of course, we had backups in case people were trapped and couldn’t get out from where they were.”

Dr. Ritch said he learned the importance of being able to prioritize which patients needed to be rescheduled urgently and figuring out which cases could be canceled or rescheduled.

“A lot of it had to do with informing patients and letting them know the plan, so they didn’t feel like they were left in the dark,” he said.

Dr. BaumA New Orleans-based urologist in private practice on Aug. 29, 2005 when Hurricane Katrina hit, Neil Baum, MD, was shut down for 12 weeks because of the natural disaster. Dr. Baum said he was on top of the world before the category 3 hurricane hit New Orleans, and, basically, unable to work at his practice in the days, weeks, and months after.

Dr. Baum, who today is professor of clinical urology at Tulane University School of Medicine, said he was so distraught about Katrina’s devastation that he wrote a book to help others,  “Disaster Planning for the Clinical Practice.”

Because of a mandatory evacuation, Dr. Baum couldn’t go back to his practice until November that year. He returned to a sixth-floor office with spotty elevator service, scarce drinkable water, and no air conditioning-conditions that made it challenging for patients to get to the practice and for Dr. Baum to deliver care.

“Fortunately, I had electronic medical records. Patients [had evacuated] far and wide across the country, and I was able to contact other physicians in other parts of the country to help take care of my patients,” Dr. Baum said.

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Colleagues without electronic health records, he recalls, told him their records had turned to paste from water damage.

Next: How to prepare for the next disaster

How to prepare for the next disaster

Urologists must prepare for disasters by having disaster plans in place and reviewing those plans at least annually, according to Dr. Baum.

“Disaster planning should not take place in a vacuum. To work effectively, it must be integrated into the practice routine and operating procedures,” he said.

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These are key disaster preparedness plan considerations, according to Dr. Baum:

• Get business interruption insurance, and keep in mind that payouts, if you get them, might take several months.

• Have up-to-date access to your data. Clouds have made it easier to store data off site. But even when important data is stored on clouds, urologists should have a hard disk of that data that’s up to date and can go with them should they need to evacuate.

• Have a phone tree for all your employees, vendors, drug reps, and other people who are important for the practice to run. The phone tree, or listing, should be updated at least quarterly and include alternate numbers, when possible.

• Remove medications and things that are refrigerated from your refrigerators when you evacuate. “I lost thousands of dollars worth of very valuable medications because I didn’t do this,” Dr. Baum said.

• Put all practice valuables in a “recovery box,” which you’ll take with you if you have to leave before an impending crisis. The box should have copies of medical records, business records, medical licenses, diplomas, tax returns, insurance documents, and the practice procedural manual. The phone tree should be in there, as well as a visual and written list of your inventory, including pictures and sales receipts for devices and computer equipment. The documentation will help you recover the value of what was inside the practice.

• You might want to take a few supplies if you think you’ll have to practice off site after a disaster. Dr. Baum said he moved his office to Baton Rouge for a while after Katrina, and it helped that he had taken stethoscopes, blood pressure cuffs, and other basic medical supplies to work at the temporary office.

• Appoint an emergency management team, if your practice is large, or an emergency captain, if your practice is small. The team or captain would be charged with coordinating what needs to be done before, during, and after a disaster.

Finally, don’t forget about you.

“Personally speaking, we also have to be prepared,” Dr. Ritch said. “You can get caught up in taking care of your patients and forget to get your own water, gasoline, and all these things. If you’re not prepared and can’t do your job, that affects your ability to take care of people.”

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