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Put It on the Board, 10/17

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Houston labs learn: know the back roads

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Houston labs learn: know the back roads

The disaster plan of the laboratories at Memorial Hermann Health System in Houston held up well in Hurricane Harvey, thanks to lessons learned in years past, but the labs have something new to add: Know in advance the back-road access routes to the various hospitals.

Dr. Brown

Dr. Brown

Unlike previous storms, Harvey caused unforeseen and extended road and highway closures, forcing laboratory leaders to improvise courier routes and adjust staffing plans while some hospitals remained inaccessible for up to a week.

“We really depend on our highways here in Houston,” says Richard Brown, MD, medical director for laboratory services. “Our couriers did an amazing job, and we did not have any specimens lost due to loss of integrity. Our blood supply remained in date and maintained the appropriate refrigeration. Everything worked, but it was difficult, as we had to rely on the staff of each hospital to find and communicate to us the accessible routes on a daily basis. Now we know the back roads that do not flood, and next time we’ll know in advance the alternate routes we need to use.”

The road closures also prevented team B staff from getting to the laboratories to relieve team A staff for the first two to three days post-hurricane. Team A staff at the core laboratory bunked in with sleeping bags in the laboratory office suite and worked 12-hour shifts until reinforcements arrived. “The laboratory staff were just incredible,” Dr. Brown says. “They spelled each other so that somebody would be ready to go at all times.”

Lessons learned from Tropical Storm Allison in 2001 and Hurricane Ike in 2008 helped Memorial Hermann’s laboratory professionals prepare for expected disruptions this year, Dr. Brown says.

Sandra Ratliff, system vice president for laboratory services, began holding conference calls 24 to 48 hours before Harvey was predicted to make landfall. On the twice daily calls, at 8 AM and 2 PM, were Dr. Brown, all Memorial Hermann Health System laboratory directors, its courier service supervisor, and representatives from the health system’s reference laboratory and regional blood supplier. The calls were especially effective in helping Memorial Hermann prepare for potential areas of shortfall in staff and supplies.

“That was the great success story,” Dr. Brown says. “We were able to lay in enough supplies of blood in advance, particularly red cells. We also overstocked on our major chemistry, hematology, and coagulation reagents.” In retrospect, the labs should have increased the level of supplies from the smaller vendors, such as for microbiology and immunology, because airport closures made it impossible to receive deliveries from outside the region for an extended period.

“The most unanticipated thing with this storm was the length of time that the major highways into Houston and both airports were shut down,” Dr. Brown says. Although Allison and Ike dumped significant amounts of rain over Houston, “it was over a relatively short period of time, so the flooding came and went on the highways. Here, we got continuous rain for four days and that ended up being 51 inches—a whole year’s worth of rainfall. There’s just no way to recover from that.”

Preparing to keep laboratory staff fed, hydrated, and rested was a lesson learned years ago.

“We learned that from Ike,” Dr. Brown says. “There was a lot of power loss and the cafeterias shut down, so there was no food. We anticipated that this time and made sure all the employees had snacks, plenty of bottled water, and a good place to sleep.”

Dr. Brown shares another lesson, one that preserved supplies when Memorial Hermann was forced to evacuate an acute-care hospital near the rapidly cresting Brazos River.

“When you close a facility and you’re closing down a lab, take everything perishable out. Take all the blood, take all the supplies, and move them to where the patients are going,” he says.

Memorial Hermann learned that lesson after a hospital evacuation during Hurricane Ike. “We just left everything in place thinking it was only going to be a short period of time,” he recalls. When the power and the backup generators failed, “we lost the blood and the supplies.”

A new lesson learned in the Harvey evacuation: Include phlebotomists in the move to the receiving hospital. “It was not a nurse-drawn facility, so even though all of the nursing staff accompanied the patients, we had to have somebody come over to draw those patients’ blood,” he says. “We moved everything needed to maintain laboratory services with the patients, and that’s a valuable lesson learned.” —Amy Carpenter Aquino

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