Monday, March 2, 2015
What the Northeast's snow preparedness can teach hospitals in winter
Significant snow in New England every winter is about as certain as sun in Florida every summer. When I moved to the USA from the south of (old) England to do my medical residency in Maryland, my first few years living in the United States were relatively snow-free. But when I started my first job as an Attending physician in central Massachusetts, I was in for a big shock. I had never yet shoveled snow in my life, but soon realized it was a rite of passage every winter in this part of the world.
Having now lived here for the last several years, I've become as used to it as all the seasoned New Englander's around me. Every winter the heavy snow invariably comes, and every winter I'm always impressed by how quickly towns and cities work to prepare beforehand and rush to clear the roads in lightning quick time afterwards. 
The large snow blizzards this winter, followed by more—again showed the importance of preparation for any big task (see the above picture of my car buried in the snow, the roads around it quickly cleared by the Boston snow plows within a couple of hours). Hundreds of trucks stood ready and hundreds of emergency personnel were drafted in for the clean-up efforts.
And sticking with this theme of winter, speaking as a doctor who has worked in a lot of different hospitals in the Northeast, I believe that hospitals can learn an awful lot from how towns and cities prepare for snowstorms. The typical scenario for hospitals goes something like this: winter comes and thousands more people fall sick: coughs, colds, pneumonias, and of course the dreaded flu. For the already sick and frail, it doesn't take much to push them over the edge to the point where they need a hospitalization. It happens every winter across the country, resulting in hospitals experiencing a “surge” of patients. Yet still every winter, many hospitals are taken off guard and struggle to cope with the increased need. Resources and staff are stretched, and ultimately patients have to wait longer for much needed services.
Instead of this situation always happening, hospitals could prepare better by:
• convening committees in the Fall to discuss and implement upcoming winter arrangements,
• creating a nursing staffing winter schedule to ensure a “float pool” of extra nurses,
• having for certain medical specialties such as Emergency Medicine and Hospital Medicine a special winter schedule that includes extra available physicians, made well in advance (not at the last minute),
• forming arrangements with neighboring hospitals for emergent bed diversion situations, and
• planning to reduce the volume of elective cases such as orthopedic surgeries during winter months in order to free up beds for other medical cases.
Winter patient surges for hospitals are only likely to become more severe with the ageing population and increase in chronic conditions including chronic obstructive pulmonary disease and congestive heart failure. Rather than being caught out, hospitals would do well to remember what Benjamin Franklin said about any big task: “By failing to prepare, you are preparing to fail.”
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.
Labels: emergency response, guest post, hospital medicine, preparedness, staffing, Suneel Dhand
posted by Suneel Dhand at
11:00 AM
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
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MD
Albert Fuchs, MD, FACP, graduated from the
University of California, Los Angeles School of Medicine, where he
also did his internal medicine training. Certified by the American
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full-time faculty member at UCLA School of Medicine before opening
his private practice in Beverly Hills in 2000.
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Amanda Xi, ACP Medical
Student Member, is a first-year medical student at the OUWB School
of Medicine, charter class of 2015, in Rochester, Mich., from which
she which chronicles her journey through medical training from day
1 of medical school.
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Ira S. Nash,
MD, FACP, is the senior vice president and executive director of the North Shore-LIJ
Medical Group, and a professor of Cardiology and Population Health at Hofstra North
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Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and
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Controversies in Hospital
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Run by three ACP
Fellows, this blog ponders vexing issues in infection prevention
and control, inside and outside the hospital. Daniel J Diekema, MD,
FACP, practices infectious diseases, clinical microbiology, and
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Robert M. Centor, MD, FACP, contributes short essays contemplating
medicine and the health care system.
Suneel Dhand, MD, ACP Member
Suneel Dhand, MD,
ACP Member, is a practicing physician in Massachusetts. He has published numerous
articles in clinical medicine, covering a wide range of specialty areas including;
pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also
authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His
other clinical interests include quality improvement, hospital safety, hospital
utilization, and the use of technology in health care.
DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about
health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more
than a decade and is an Associate Professor of Medicine at an
academic medical center on the East Coast. His time is split
between teaching medical students and residents, and caring for
patients.
Everything
Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science,
medicine, health and healing in the 21st century.
FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the
Internal Medicine Residency and Assistant Dean of Scholarship &
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Chicago. Her education and research focus is on resident duty
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illuminates the emotional and cognitive aspects of caregiving and
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Ryan Madanick, MD, ACP Member, is a gastroenterologist at the
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Informatics
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William Hersh, MD, FACP, Professor and Chair, Department of Medical
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David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned
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Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of
hematology and medical oncology. His blog is a joint publication
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KevinMD
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MD
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Elaine Schattner, MD, FACP, shares her ideas on education, ethics
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researcher in cancer immunology, and as a patient who's had breast
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Mired in MedEd
Alexander M.
Djuricich, MD, FACP, is the Associate Dean for Continuing Medical
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blogs about medical education.
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Rob Lamberts, MD, ACP Member, a med-peds and general practice
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Distractible Kind).
Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a
small community hospital in Connecticut. His blog is a series of
musings on medicine, medical care, the health care system and
medical ethics, in no particular order.
Reflections of a Grady
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Kimberly Manning, MD, FACP, reflects on the personal side of being
a doctor in a community hospital in Atlanta.
The Blog of Paul Sufka
Paul Sufka,
MD, ACP Member, is a board certified rheumatologist in St. Paul,
Minn. He was a chief resident in internal medicine with the
University of Minnesota and then completed his fellowship training
in rheumatology in June 2011 at the University of Minnesota
Department of Rheumatology. His interests include the use of
technology in medicine.
Technology in (Medical)
Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in
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Peter A. Lipson,
MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and
teaching physician in Southeast Michigan. The blog, which has been
around in various forms since 2007, offers musings on the
intersection of science, medicine, and culture.
Why is American Health Care So Expensive?
Janice
Boughton, MD, FACP, practiced internal medicine for 20 years before
adopting a career in hospital and primary care medicine as a locum
tenens physician. She lives in Idaho when not traveling.
World's Best Site
Daniel Ginsberg, MD,
FACP, is an internal medicine physician who has avidly applied
computers to medicine since 1986, when he first wrote medically
oriented computer programs. He is in practice in Tacoma,
Washington.
Other blogs of note:
American Journal of
Medicine
Also known as the Green Journal, the American Journal of Medicine
publishes original clinical articles of interest to physicians in
internal medicine and its subspecialities, both in academia and
community-based practice.
Clinical
Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP
Member, associate program director at New York University Medical
Center's internal medicine residency program. Faculty, residents
and students contribute case studies, mystery quizzes, news,
commentary and more.
Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so
he can create an independent, clinician-reviewed space on the
Internet for physicians to report and comment on the medical news
of the day.
PLoS Blog
The Public Library of Science's open access materials include a
blog.
White Coat
Rants
One of the most popular anonymous blogs written by an emergency
room physician.
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