CHICAGO — In the fall of 2006, a vendor accidentally cut the wrong cable in the computer room at Children's Specialized Hospital, New Brunswick, N.J., leaving the large pediatric rehabilitation provider's eight facilities without computers or phones for 3 days.
Staff continued to care for patients with the semimanual systems that were still in place, and no adverse events occurred as a result of the extended power loss. But the sobering experience sparked a comprehensive overhaul of the organization's communications downtime policies and procedures using a Six Sigma risk-reduction tool known as FMEA (Failure Modes and Effects Analysis). The tool, widely used in manufacturing, involves rating the risks associated with various components in a process on a numerical scale and prioritizing corrective actions according to risk level. Six Sigma is a management system first created by Motorola Inc. that seeks to improve quality and efficiency.
A root cause analysis and a review of existing policies and procedures soon after the communications failure quickly revealed serious shortcomings, including gaps between the administrative policy and the emergency operations plan, inconsistencies across some departments, no policies and procedures at all in other departments, and critical steps that were missing, including a formal process for communicating to staff that systems were down.
“The staff was completely out of the loop,” said Lorraine Quatrone, medical administrator at Children's Specialized Hospital. “We thought we had a plan in place,” but “we were operating in silos,” she said at the Joint Commission national conference on quality and patient safety.
The hospital made some quick fixes, after which “we could've sat back and said we're prepared,” said Ms. Quatrone. Instead, the hospital decided to “drill down and look behind doors” using FMEA methodology.
The major shortcoming was evident when the staff needed to be alerted of a communications failure, and they needed to know what to do to ensure patient safety once they were informed.
To make that happen, the hospital developed a standard template for downtime policies and procedures for completion by every department. In addition to asking directors and managers what their departments needed in order to continue to function in the absence of computers and telephones, the hospital also asked them to look at their departments as suppliers of information to the organization and to indicate how they could help other departments. “We wanted to make this an organizationwide commitment to helping each other,” Ms. Quatrone said.
Facilities management, for example, is now responsible for immediately distributing two-way radios to patient areas, making hourly rounds to check for emergency issues, and monitoring the energy management system. All nursing units are required to immediately begin recording the administration of all medications on a written worksheet.
The hospital also covered procedures for how each department would continue to function after systems were working again, including how information from the interim paper process would get entered into the electronic system. Once the system is operational, for example, pharmacy staff are required to enter all new medication orders electronically.
Following the revision of policies and procedures, department directors and managers were asked to educate their staff and to decide with them which electronic forms would be needed in paper form and where information should be kept. Information on the emergency plan became an integral part of new employee orientations as well.
The hospital conducted a series of simulated downtime drills. Awareness “seemed pretty low at the beginning, but as time went on and we did drills to reinforce our commitment to the process, we started to see the results edge up,” Ms. Quatrone says.