As Hurricane Sandy ripped a huge swath of destruction through the Northeast Monday, the backstop gave way at NYU Langone Medical Center.
That backstop was the medical center's electrical generators, which were needed to keep lights, ventilators, and all manner of life-sustaining medical equipment in operation.
But its generators failed and NYU Langone found itself having to evacuate some of its sickest patients during a storm that had been predicted to be "the worst case scenario," by the National Oceanic and Atmospheric Administration in a media report.
It called on Mount Sinai Hospital four miles uptown in Manhattan to take in dozens of critical patients. But Mount Sinai's intensive care beds were all full.
Some quick thinking hit on an innovative solution, says the hospital's chief medical officer, Erin DuPree, MD.
"We opened up our PACUs, our post-anesthesia care units or surgical recovery units," DuPree says. "It's one of the innovative things that we did that I don't think a lot of other places have thought of for these emergencies, and that really just set it up for the NYU (NYU Langone Medical Center) team to come in and take care of their critically ill patients."
"We said, 'you can take care of your critically ill patients here.'' We gave them emergency privileges, and we put some of our staff there (in the PACU) to help liaison and show them where the blood tubes were and the specimen bags and how to get things to the lab."
"Our PACUs had all the appropriate monitoring equipment already set up."
The PACUs, traditionally used for surgical cases during the day, are empty at night. From Monday evening until about 2:00 or 3:00 a.m. Tuesday, 1,171-bed Mount Sinai absorbed more than 50 doctors and nurses from NYU Langone, as well as some 57 of 300 evacuated patients—a number that grew to 61 or 62 when several pregnant patients in labor gave birth after their arrival.
As of Wednesday afternoon, Mount Sinai was preparing to take more patients from other hospitals that discovered damage from superstorm Sandy, such as Bellevue Hospital, next door to NYU Langone.
One challenge that Mount Sinai elevated as a top priority was for all members of their clinical teams to "be very clear for each patient coming in, that everyone knew who the doctor is who is actually taking responsibility for each patient, whether it's a Mount Sinai physician or an NYU physician, and making sure the lines of communication and responsibility are crystal clear so that nothing falls through the cracks," Dupree explained.
Mount Sinai also gave physicians and their nursing teams access to Mount Sinai's electronic medical record system on a "read only" basis to access lab and imaging results to smooth the care process.
For new clinical information needed in the charts, the NYU doctors and nurses are using hand written notes, the old fashioned way, because most do not know how to use Mount Sinai's Epic electronic health record system, DuPree says.
Most of the transferred patients' records came with the patients during their ambulance transport, in paper format in folders, stashed with the patients either on their transport gurneys or tucked in patients' arms. Langone had no power to fax over patient diagnoses, procedures, and test results, DuPree says.
"There was almost no communication (with Langone) because the communication lines were down," she said.
Despite discharging many Mount Sinai patients early and cancelling scheduled elective surgeries, Mount Sinai on Monday had a relatively full census of about 85%. "We were actively discharging patients from the time we knew the storm would be headed to this region late last week. We knew the storm was coming and we knew we needed to clear beds to make sure patients got home safely or to their destinations."
DuPree advises other hospital leaders facing a disaster situation this way: It's "most important to ensure to put your patients first, not just the safety of patients in your own institution. In this type of crisis, it really means banding together with the entire community and working with other chief medical officers and hospital presidents to make it work, and really prioritize."
It's most important, she says, "to have your lines of responsibility and communication clear."