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Preparing Your Office Practice for Disaster and Emergency Events

Idaho Bioterrorism Awareness and Preparedness Program (IBAPP)Medical Group Management Association (MGMA)

David N. Gans, MSHA, FACMPEVice President, Practice Management Resources

Medical Group Management Association

July 22, 2008


About MGMA

Our mission…To continually improve the performance of medical group practice professionals and the organizations they represent

MGMA has• 22,000 members…• Who manage and lead 12,500 organizations• With 270,000 physicians


Program Objectives

• Describe why a medical practice must be prepared for an infectious disease epidemic or bioterrorism attack

• Describe how to protect your facility, physicians, staff, and patients in the event of a natural disaster, contagious disease outbreak, bioterrorist incident, or other emergency

• Outline the key elements of a medical practice disaster plan and the resources available to assist a medical practice in the event of disaster or emergency



Why Prepare for an Infectious Disease Epidemic or Bioterrorism?


Why Prepare for an Infectious Disease Epidemic or Bio-Terrorism?• Counter uncertainty by physicians and employees regarding

local, national, and international events• Preparations for infectious disease epidemic and bioterrorism

are similar to preparations for many emergency situations• Preparations for an epidemic bioterrorism will assist

physicians and employees deal with the emotional and practical disruptions created by other emergencies and disasters

• Future probability of an event is high



The Bigger Picture: Disasters and Emergencies

• Practice Emergency: Any event that can disrupt practice flow for more than 24 hours

• Types of Disasters and Emergencies– Natural Events– Acts of Violence– Practice Emergencies– Public Health Outbreaks





Current Confirmed Human Cases of Avian Flu

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHOJune 19, 2008

2003 2004 2005 2006 2007 2008 Totalcases deaths cases deaths cases deaths cases deaths cases deaths cases deaths cases deaths

Azerbaijan 0 0 0 0 0 0 8 5 0 0 0 0 8 5Bangladesh 0 0 0 0 0 0 0 0 0 0 1 0 1 0Cambodia 0 0 0 0 4 4 2 2 1 1 0 0 7 7China 1 1 0 0 8 5 13 8 5 3 3 3 30 20Djibouti 0 0 0 0 0 0 1 0 0 0 0 0 1 0Egypt 0 0 0 0 0 0 18 10 25 9 7 3 50 22Indonesia 0 0 0 0 20 13 55 45 42 37 18 15 135 110Iraq 0 0 0 0 0 0 3 2 0 0 0 0 3 2Lao PDR 0 0 0 0 0 0 0 0 2 2 0 0 2 2Myanmar 0 0 0 0 0 0 0 0 1 0 0 0 1 0Nigeria 0 0 0 0 0 0 0 0 1 1 0 0 1 1Pakistan 0 0 0 0 0 0 0 0 3 1 0 0 3 1Thailand 0 0 17 12 5 2 3 3 0 0 0 0 25 17Turkey 0 0 0 0 0 0 12 4 0 0 0 0 12 4Viet Nam 3 3 29 20 61 19 0 0 8 5 5 5 106 52Total 4 4 46 32 98 43 115 79 88 59 34 26 385 243

Country


Healthcare Workers Have Significant Risk from Contagious Disease and Biological Agents


Staff May Not Report to Work During a PandemicReutersPandemic might keep some health staff away Updated: 4:38 p.m. MT May 22, 2007

NEW YORK - A survey of U.S. health care workers suggests that not all are willing to staff the front lines if there should be an outbreak of bird flu or other infectious disease. Some will opt to play it safe and stay home, according to the survey.

About 50 percent of the hospital workers said “yes” they would report to work, while 42 percent said “maybe” and 8 percent said “no, even if I would lose my job.” Doctors (73 percent) were more likely than nurses (44 percent) or other hospital personnel (33 percent) to indicate that they would report to work in the event of bird flu pandemic.



Protecting your facility, physicians, staff, and patients in the event of a natural disaster, contagious disease outbreak, bioterrorist incident, or other emergency


How Can You Prepare?

• Learn how to diagnose and treat patients affected with avian flue or who are exposed to biological agents and toxins

• Train staff how to recognize potential cases• Establish medical practice disaster plan• Include pandemic and bioterrorism in the medical

practice disaster plan• Develop a screening plan to identify and direct patients

with high risk for contagious disease or biological agent exposure


Ten Step Response to Pandemic or Bioterrorism

1. Maintain an index of suspicion2. Protect thyself3. Assess the patient. 4. Decontaminate as appropriate5. Establish a diagnosis6. Render prompt treatment7. Practice good infection control8. Alert the proper authorities9. Assist in the epidemiologic investigation10. Maintain proficiency


Screening Patients with a High Risk for Contagious Disease or Biological Agent

• If there is a risk of pandemic or biological attack, train receptionists to use a script that can identify patients at risk

• Validate screening by triage nurse or physician• Direct patient to the appropriate health care services

– Monitor symptoms for the scheduled appointment– Come immediately to the doctor’s office– Go directly to a designated health care facility– Call 911 for the Emergency Medical Response

(EMR) system.


Sample Script for Receptionists to Use in Screening PatientsKey questions– Symptoms– Travel– Military service– Mass transit– Public gatherings


Sample Script for Receptionists to Use in Screening Patients

• Fever?• Fatigue?• Sore throat?• Difficulty swallowing?• Nausea?• Vomiting?• Coughing?

• Headache?• Back pain?• Chest pain?• Abdominal pain?• Chills?• Sweats?

How long have you had these symptoms? (Score: Less than week = 2 points, More than a week = 1 point)

What symptoms do you have? (Score 1 point for each symptom)


Sample Script for Receptionists to Use in Screening PatientsHave you traveled outside the United States recently? If

yes,• When did you leave the US?• What countries were you in? (Score 1 point for each

country)• When did you return? (Score: Less than a week=2

points, More than week=1 point)


Sample Script for Receptionists to Use in Screening PatientsAre you currently, or have you been in the military? If yes,• Were you stationed outside the US? (Score 1)• When were you discharged? (Score: Less than a

month=2 points, More than a month but less than year=1 points)



Have you recently utilized mass transportation? If yes, (Score: If used all the time or within the past weeks = 2 points, otherwise 1 point)

• Subways?• Buses?• Trains?• Airplanes?

Have you attended any large gatherings recently? If yes, (Score 1 point for each positive answer)

• Where?



A score in the range of eight (8) or more might indicate that a patient may be at risk of exposure to a contagious disease or biological agent and should be referred to a physician or triage nurse who can better assess the situation and direct the patient to come immediately to the doctor’s office, to a designated health care facility, or to instruct the patient to call 911 and notify the Emergency Medical Response (EMR) system.

If the patient is asked to come to the physician’s office, upon arrival they should be isolated immediately.

Walk-in patients also should be asked the appointment triage questions at the front desk and isolated from public areas based on the scoring.



Designing a disaster plan for your medical office


Sections of a Medical Practice Disaster Plan

• Preparation – What you do before disaster strikes• Survival – Immediate actions• Recovery – Coming back after the smoke clears


Reverse Planning Helps Keep the Task in Perspective• Visualize what a successful recovery would look like• Break a large problem into manageable tasks• Evaluate each task in terms of how much closer it

brings you to the goal


Recovery

• What do you need to get back in business?• Who can help?• What resources are available?• Prepare for the worst - hope for the best• Patient care delivery – who, what, where• Communications - telephone, fax, e-mail, etc.• Supplies• Information processing and medical records recovery• Staff availability• Financial resources• Stress management


Survival

• Rapid actions – prioritize because there is never enough time to get it all done

• Patient and staff protection is first priority

• Practice makes perfect - have a “fire” drill

• Communication must be concise and clear

• Activity is reassuring in fearful situations

• Account for everyone• Rely on checklists instead of

memory• Train and drill yearly


Preparation

• Assess vulnerability• Develop a emergency plan

that fits each scenario – one size does not fit all

• Consider both isolated and community wide events

• What systems are needed for ongoing operations?– Information Technology– Financial– Human resources

• Who do you need to coordinate with?– Hospital– Other physicians– Suppliers, etc.


Assessing the Potential Impact of an Event

• Will it result in:o Injury or loss of lifeo Business interruptiono Reduce staffing or

patientso Impact financial

processo Are there fines or

penalties?

• Work the most serious and probable problems first

• What can you cover with insurance?

• What are your existing resources?

• Develop a plan to fill the gaps


Steps for Developing a Disaster Plan

• Keep the plan simple• Obtain copies of disaster plans from hospital(s) and other physicians• Obtain copies of community disaster plans• Model the practice’s plan on hospital and community plans• Let the plan reflect uniqueness of practice staff and resources

available• Distribute draft to physicians, nurses, and key staff member for input• Review plan with appropriate hospital/community entities, defining

role of the practice within framework of community disaster plans


Steps for Developing a Disaster Plan (continued)

• Finalize plan, including group governance approval• Implement emergency response plan• Develop training modules• Conduct initial and on-going physician/staff training

program, including testing and simulation• Re-evaluate and update emergency response plan

annually


If an Emergency or Disaster Happens, Learn from It• Debrief all involved parties and look how to improve the

plan• Recognize the circumstances are never exactly the

same• Stay vigilant for symptoms of stress in the staff,

physicians, and you



Federal and Community Agencies Providing Emergency Assistance


Federal and Community Agencies Providing Emergency Assistance• The emergency preparedness system is

fragmented with overlapping responsibilities at federal, state, and local government level as well as multiple private organizations having stakeholder interests

• Tip O’Neal described, “All politics are local.” The same is true for emergency assistance


FEDERAL GUIDANCE TO IMPROVE STATE-LEVEL PANDEMIC INFLUENZA OPERATING PLANS

Presented to the American States, Territories and District of Columbia

By U. S. GOVERNMENT

March 11, 2008


State Guidance

States should plan and develop pandemic influenza plans with local, regional, State, and federal partners. Planning should include, but is not limited to the following:

Form community-wide coalitions to include hospitals, urgent care facilities, other ambulatory care facilities, public health, long term care facilities, nursing homes, home health care agencies, community health centers, primary care offices, mental health and substance abuse treatment facilities, EMS, and other first responders to accommodate surge in patients expected from pandemic influenza.


Idaho Bureau of Homeland Secruityhttp://www.bhs.idaho.gov/index.htm


Federal Emergency Management Agency (FEMA)(http://www.fema.gov/)


Centers for Disease Control and Prevention (CDC)(http://emergency.cdc.gov/)


American Red Cross Disaster Services(http://www.redcross.org/services/disaster/)


Small Business AdministrationDisaster Assistance(http://www.sba.gov/services/disasterassistance/index.html)


IBHS Information for Business(http://www.ibhs.org/ibhs2)


Employer Support of the Guard and Reserve (ESGR)(http://www.esgr.org)


Questions?

David N. Gans, FACMPEVice President, Practice Management Resources

Medical Group Management Association104 Inverness Terrace East, Englewood, CO 80112

877.275.6462 ext. 1270

[email protected]

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