Practice Interrupted


From a burst water pipe to a cataclysmic disaster, being prepared for whatever nature’s wrath or man’s mistakes may bring is crucial to keeping your practice — and your patients — safe. 

Disasters in the medical office run a gamut of exposures. From something as routine as a fire, to hurricanes, tornadoes, or flooding, these situations require planning to lessen their impact on both the practice and your patients.

“Many physicians don’t believe that disasters will ever happen to them or they are too busy with other things to think about it,” says Owen Dahl, Owen Dahl Consulting, Th e Woodlands, Texas. “However, now is the time to plan for emergencies. You have a lot of decisions to make in a very small time frame and this is not the time to make up interventions as you go along.”

There are three major areas of concern to be addressed. The first is reconstituting the medical side of the practice. The second is putting the business side back together. The third is the continuing need to take care of your patients.

Medical Record Recovery

“One of the most important things is having medical records available in a timely fashion,” says Vivian Fonseca, MD, chief of the endocrinology section at Tulane University Health Sciences Center, in New Orleans, La. “With the adoption of electronic health records (EHR) that is very doable. You should be backing up these files up to the cloud or off site storage daily as part of regular office routine.”

Under these circumstances, planning centers on making sure the practice and/or its information technology people know how to remotely access the records. If you back up to hard drives and take them off site, make sure that whoever has that responsibility puts them in a safe place that can be easily accessed. Know that if a disaster occurs, the backups may not be readily available if the storage site is also destroyed. Even a safety deposit box in a bank can cause concerns if the branch is closed.

Reconstituting the Business Side

Routine procedures should also take care of the need to back up major business records. Again, the main thing for planning purposes is to know where the copies are and how to access them remotely.

“A consideration is making sure your insurance coverage is adequate,” Dahl says. “You want to have business interruption insurance to pick up costs and replace revenues. Talk to your insurance provider to make sure you are covered for all likely hazards. Most plans won’t cover flood damage, for example.”

Another integral part of disaster planning is where to relocate the office. There
should be multiple plans based on the likely size of the problem.

For example, reciprocal agreements with another physician on the other side of town will suffice for fire and possibly for flood. If tornadoes occur, then you may want to work with practices in another county or nearby city. Hurricanes may require relocating to another state altogether. If you lease your office space, ask your landlord about emergency plans they might have to disperse their tenants among other buildings they own.

Keep in Touch

Also work out ahead of time how staff and patients will be advised of changes. Personnel phone and email information can be printed and held off site. Patient data can be extracted from the EHR when it is back online. Also look at alternative channels including local and social media to get the word out.

Some disasters such as snowstorms and hurricanes may give you enough time to notify all concerned of what to expect. Fires or tornadoes often require your response in real time.

Helping patients through disruptions in service related to a disaster can be viewed as a part of “first, do no harm.” Patient-related interventions should be part of patient teaching and go past merely how to stay in touch with the doctor.

Patient Education

“I was a physician in Houston and worked with many of the patients evacuated from Louisiana following Katrina,” says Rubina Heptulla, MD, division chief of pediatric endocrinology and diabetes at The Children’s Hospital at Montefiore in New York City. “Many showed up without medical records.”

Although EHRs and patient portals may alleviate some of this problem, there is still likely to be a lead time between the time of the disaster and when these become available again. Heptulla suggests that patients keep insulin pump settings, insulin types and dosages, and similar information readily available.

“The Federal Emergency Management Agency (FEMA) suggests those with chronic illnesses have three days of medical supplies at hand,” she says. “My personal suggestion would be five to seven days since it could take a while for deliveries to be made or drug stores to reopen. Medications, testing strips, and other required essentials should be put into an emergency kit that you can get to quickly.”

She notes that the American Diabetes Association has a suggested emergency kit, and you can get more general checklists through your local emergency management agency or the FEMA website. Most disasters happen during a season so it makes sense to update your patient’s plan and kit a month or two before they are likely to be needed.

Although it may seem daunting, planning for a calamity can be fairly easy.

“There are a lot more problems related to not having a plan than there are to setting one up,” Dahl says. “Your affiliated hospital may have an emergency planner that they can make available to the practice. Your local and state emergency management agencies are more than happy to assist in both initial and ongoing planning. You can go to FEMA’s website and pull up checklists that can help you get your responses ready quickly.”

Ullman, RN, MHA, is an Indiana-based freelance writer with nearly 30 years of experience. He wrote about endocrine nurses in the July issue. 

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