Branching Points and Skill Sets
What will your community expect your institution to respond to and provide in the event of disaster? Here is where hospitalists can delineate what they can do when the time comes, says Erin Stucky, MD, a pediatric hospitalist at Children’s Hospital, San Diego.
“Most disaster preparedness algorithms have roles based on ‘hospital-based providers,’” she says, “but when it comes down to medical administration, many of them stop at the emergency department.”
From that point on they are likely to say “I don’t know”—that is, the rest of that decision tree is left in the hands of whoever is in the lead positions of physician, administrator, and nurse.
“That’s where the hospitalist can say, ‘Let me tell you my skill set,’” says Dr. Stucky, such as “I can triage patients; I can help to coordinate and disseminate information or help to outside providers who are calling; I can help to coordinate provider groups to go to different areas within our hospital to coordinate staffing … because I know operating rooms or I know this subset of patient types.”
At some institutions where hospitalists have been around for a longer time the disaster plan’s algorithm has branching points that don’t end in the emergency department. “Each [branch] has separate blocks that are horizontally equivalent,” says Dr. Stucky, “and the bleed-down [recognizes] the hospitalist as the major ward medical officer responsible for ensuring that floor 6, that’s neuro, and floor 5, hem-onc, and so on, have the correct staffing and are responsible for people reporting to them as well as dividing them as a labor pool into who’s available to go where.”
In general, however, regardless of setting, she says, a “hospitalist knows intimately the structure of the hospital, the flow between units, and can help other patients to get to different parts of the institution where care is still safe, such as observation areas.”
Communications: Up and Down, Out and In
Part of the global-facility thought process must include what communications will be for everything from the county medical system and EMS response to, within an institution, the communication between floors and between people on horizontal lines of authority. In addition, information in and out of the hospital from workers to their families is crucial so that workers can concentrate on the tasks at hand.
Questions must be considered ahead of time: How do I communicate to those people outside whom I need to have come in? How do I get response to the appropriate people who are calling in to find out how many patients we’re caring for? There may be other calls from someone who says, for example, that the ventilator has stopped working for her elderly mother.
And hospitalists must also be ready to support the urgent care or primary care satellite clinics and communicate what’s going on at the hospital, says Dr. Rathbun, “so that someone like me, who is a primary care practitioner in the community, can know that if I call this number or this person, I’m going to be able to say, ‘I’m down here at the [clinic] and here’s what I’ve got,’ or “I know things are terrible, but I have a diabetic you had in the hospital three weeks ago who’s crashed again, and you’ve got to find him a bed.’”
Communication plans might include the provision of satellite phones or two-way radios, says Dr. Stucky, and this will affect concrete issues, such as staffing and allowances for who can come and leave.
“In our institution we make this [communication] a unit-specific responsibility of the nurse team leader,” she says. “The nurses each have a phone and those nurse phones are freed up for any person available on that unit to be used to communicate with the outside world.”