Curbside Consult with Dr. Jayne 10/29/18

I happened to be in New York this week during the pipe bomb scare, close enough to the CNN offices to receive an emergency alert on my phone advising me to “shelter in place.” The presenter in the continuing education seminar I was attending must have seen everyone checking their phones even though they were supposed to be silenced, so she stopped the presentation to find out what was drawing everyone’s interest.

People were texting friends and family members to let them know that they were OK or were looking for news on what was happening in the neighboring building. It was clear that with everything going on there wasn’t going to be much learning happening, so the conference organizers wisely instituted an unplanned break.

Although most of us were from out of town, several physicians at the table in front of me were residents of the city who had been in practice there during the World Trade Center attacks in 2001. They began talking about what it was like that day, being put on alert by their hospitals that they should prepare for a mass casualty event. They talked about the preparations to receive hundreds of patients, including possible air transports to hospitals outside the city, as the events began to unfold. They also talked about the horrible experience of waiting for patients who never arrived and how that affected them as clinicians. It was clear that even after so many years, they are still profoundly impacted by the events of that day.

The conversation moved into one around disaster preparedness and what is different for them now compared to what was in place then. As we talked, they were checking in with their hospitals to let them know their location and status should there be an actual bomb detonation. By that point, we were informed that our building was on a modified lockdown procedure, with guests and employees being encouraged not to leave and no one allowed to come in. I assume they would have allowed physicians to leave in the event they were needed emergently, but I’m glad the incident was resolved relatively quick and we never had to find out how the lockdown really worked in the lobby.

There was a side conversation about the fears that clinicians and others that work in hospitals carry with them. People are afraid of how they might react to a disaster or mass casualty situation, whether they would be able to stay the course and care for patients or whether they would want to focus on making sure family and other loved ones are safe. A few mentioned episodes of violence they had experienced in their own hospital workplaces, including assaults on patients and staff and even an active shooter event. Nearly everyone mentioned a higher frequency of drills and discussions of potential dangers, with several in the conversation noting that the ongoing drills and reviews are likely contributing to the anxiety.

The fear of violence has influenced technology purchasing decisions. Hospitals are installing advanced security systems and some require visitors to present identification so they can be credentialed to enter the facility. Visitors are wearing stickers with their names, pictures, and sometimes their destination, such as a room number or office suite. It’s different from back in my Candy Striper days when we looked up the patient’s name on a printout, told the visitor the room number, and pointed them towards the elevators without a second glance. I don’t think there are too many facilities that would leave a lone 13-year-old girl manning the front desk any more.

We talk a lot about EHRs, revenue cycle platforms, clinical and financial analytics, telehealth platforms, and the numerous systems that support our hospitals and practices. Although I’ve seen the booths for security vendors at HIMSS, I’ve not had the chance until recently to reflect on those additional systems that CIOs might be called on to select and support in order to ensure business continuity for the facility. One vendor’s website notes their commitment to using big data to analyze incidents and predict patterns in order to better protect patients and staff. That’s a tall order to consider for those of us who are more used to contemplating PHI breaches than we are to thinking about breaches of the physical perimeter.

Although we have a panic button under the front desk of each of our clinic locations, I’ve been fortunate in not being at work in a situation where the staff had to use it. The staff has activated it on accident and based on the anxiety level while they worked to get it resolved, I can’t imagine what they would feel like in a live-use scenario.

In past clinical positions, I’ve worked at facilities where I had to park my car in a chain link enclosure inside the parking garage. I have staffed emergency departments where metal detectors and armed guards were just part of the daily scenery. We performed “fit for confinement” examinations on prisoners being transported by law enforcement, so on any given shift, there might be a patient handcuffed to the gurney. In those situations the potential risk was visible and fairly obvious and we grew to accept it as part of the job, but we didn’t think much about some of the other dangers that might come our way.

I would be interested to hear from readers on the state of security in their facilities and whether their organizations are using technology to help mitigate threats to patient and staff safety. In the times we live in, there is more to think about then tornadoes, fires, floods, and hurricanes.

What keeps you up at night about safety or potential disasters that might impact your organization? Leave a comment or email me.

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