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CA Wildfires: Operation Evacuation

The Other Side of the Evacuation

Just as Pomerado was moving patients out, eight hospitals in the region were gathering resources to take them in. Kaiser Permanente San Diego Medical Center was one that accepted nine acute-care patients from Pomerado and 10 from the skilled nursing center. Physicians from Kaiser Permanente spoke with ADVANCE about the other side of an evacuation-what happens when a hospital agrees to take evacuated patients in.

Kaiser Permanente San Diego Medical Center ran a 24-hour emergency operations center during the week of the wildfires to deal with the influx of calls.
William C. Cory, MD, assistant area medical director for Kaiser Permanente's San Diego Medical Center, was there on Monday Oct. 22 when patients from Pomerado rolled in. "They arrived pretty much in a wave," Dr. Cory said. "We had already established their level of care and where they would be bedded within the facility. That ran amazingly smooth given the urgency of things."

The transfer packets Pomerado sent with the patients significantly helped with the seamless continuity of care Kaiser Permanente was able to provide. "In a disaster like this-absolutely," Dr. Cory said. "Any time you can bundle histories, lab work and progress notes in an organized fashion it expedites the care. In my particular case, I didn't have to call back [to Pomerado] at all."

Helping the transition even more was the fact that Kaiser Permanente contracts beds with Pomerado-the only acute-care hospital in the Eastern part of the county. This meant that some patients evacuated from Pomerado were actually in the care of Kaiser physicians, and already had their medical information loaded in the hospital's electronic medical record (EMR), KP HealthConnect.

"We had the ability to access some of the patient's medical records both ambulatory, previous discharge summaries, histories, physicals and consults," Dr. Cory explained. "The transition was about as seamless as you could hope for."

Cindy Guinto, RHIT, director of hospital records/transcription for Kaiser, explained that discharging Pomerado's patients once they were able to return to the hospital went equally as smoothly as taking them in. At the end of their stay, the complete packet of information-from the paper they came in with to anything generated at Kaiser-was assembled to a permanent record, and transfer summaries were dictated and transcribed accordingly, Guinto explained.

"Everyone did a great job in making the transfer summaries available right away, from the doctors getting them dictated, to MTs getting them transcribed timely so the patient could go back to the facility as soon as possible," Guinto explained.

Staff from Kaiser Permanente worked 12-hour shifts to make sure the emergency operations center was staffed 24-hours a day.
The physicians from Kaiser also described how they were able to adapt the week of the wildfires and care for their patients regardless of how far in distance the evacuation took them from direct care. With 20 outpatient medical facilities throughout San Diego county, and KP HealthConnect completely live on the outpatient side, physicians were able to get instant and remote access to patient charts, said Jay Mongiardo, MD, MBA, Southern California Permanente Medical Group and San Diego East County physician leader for primary services.

Many Kaiser physicians, like Dr. Mongiardo, were able to pull up their appointment list and make calls to patients at home to see if the consultation or assessment was something they could do over the phone. With computerized physician order entry (CPOE), Dr. Mongiardo was then able to fill prescriptions or move them to different pharmacies so patients who were evacuated miles away were still able to receive treatment. It was an ideal response to the full-scale health alert that warned everyone to stay indoors-particularly those with respiratory conditions-to avoid the choking smoke and ash that filled the city, Dr. Mongiardo noted.

"It was a way to keep people at home, in a safer environment," he said. "We were doing the best job for patients in the situation."

Being able to adapt in the time of an emergency verifies the true importance of EMRs to patient care, Dr. Mongiardo asserted. "The ability to instantly access all of my patient's information from my house and instantaneously send orders to any pharmacy anywhere in San Diego really shows the next generation of health care," Dr. Mongiardo said. "You can see we're in a new, different era of medicine."

CA Wildfires: Operation Evacuation

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a great article. We are much, much larger, but we can still use some of these ideas/processes in formulating our own plan. Thank you.

Betty Garard,  Dir., HIM,  Halifax HealthDecember 05, 2007
Daytona Beach, FL


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