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Shuttered windows at Boca Raton Regional Hospital-Braccili

EDITOR’S NOTE: On Thursday evening, Hurricane Matthew became a non-event in Dade and Broward counties and the southern portions of Palm Beach County where Boca Raton Regional Hospital is located. Nonetheless, the hospital continued to execute medical emergency procedures. Rudy Braccili, the hospital’s executive director of revenue cycle services, filed this story as Florida Gov. Rick Scott described as the situation as the “biggest evacuation ever” for The Sunshine State.

With less than six hours before sustained hurricane-force winds are forecast to engulf the Southeast Florida coastal region, and a mere two hours prior to when tropical storm-force winds are expected to arrive, I sit at my computer workstation. I have just pried open a set of hurricane shutters barring entrance to the building housing my office, which is situated just across the road from my beloved hospital, Boca Raton Regional.

Hurricane shutters were not supposed to have been locked in place until three hours from now. I had specifically checked about the timing for the closure, having asked our hardworking, capable facility management team lead. Their lives, no doubt, were turned upside down a week ago, when local weather folk first began mentioning a tiny dot on the radar screen: Tropical Storm Matthew moving forward a few thousand miles from the U.S. mainland. Andy, who heads up the facility management team, assured me I would have access to my office until at least noon today – hurricane day. 

But there is no time, no use, and no place for blame, whining, or discussion during a real natural disaster. Even the best-laid plans often go by the wayside in favor of practical go-from the-gut judgment and decision-making. 

During Hurricane Andrew nearly 25 years ago, many skilled nursing facilities had no choice but to load patients into ambulances or reasonable facsimiles and send them to the emergency department of my then-mother hospital, which had already locked (yes, locked) the emergency room entrance for the duration of the storm. 

What is an administrator to do under such unforeseen circumstances? Or when, just four hours into lockdown, the facility’s sewer system backed up, leading to overflowing toilets throughout several wings of the hospital, with the stench endured by courageous and loyal hospital employees for the next few days. These were employees who had opted to work “during” (E2’s, we call them), as opposed to “prior to” (E1’s) or “after the storm” (you guessed it…E3’s). 

And who in our industry can ever forget the horror brought about by Hurricane Katrina, accompanied by the deadly combination of poor planning and questionable leadership, which led to the deaths of several New Orleans nursing home patients; may their souls rest in peace.

I thought about those long-ago tragic and unpredicted circumstances as I sat in a hurricane preparedness emergency meeting two days ago, listening as each department leader – myself included – readily responded with a verbal “we are ready” or “good to go” as department names were read alphabetically during a roll-call readiness check-in.

Had we really considered and planned adequately for all possible worst-case scenarios, though? Or were we second-guessing the weather people, thinking, “sure that the storm won’t be that bad here…” or “it will probably miss us again.” After all, there were all those years gone by when we prepared to the Nth degree, only to see the storms veer hundreds of miles away from the predicted path. 

At the meeting we were listening to reports of patients who did not want to be discharged, fearful of what it might be like at home during the storm. What to do? One important function of hurricane preparedness is this: a few days in advance of the storm, empty the house of all patients who do not medically require hospitalization – appropriately and safely, but more aggressively than might otherwise be the case.

Elective surgeries and special procedures that could result in prolonged post-procedure observation stays had been cancelled a day in advance of the storm. Beds are needed for physicians and residents who are required to stay in-house for as much as four to six nights, depending on conditions surrounding the facility post-storm. 

And there is also the matter of family members of essential employees needed during the storm as well. Plus beds are needed for the unpredictable mass casualty situations that may arise. There is an excitement in the air in the days leading up to a storm like this one,  a feeling of being a part of a team charged with a mission that is really important, unpredictable, and even dangerous.

I’ve always loved working at hospitals. I’ve done so since 1977, when as a high school senior I spent weekends and holidays registering patients in the emergency room (that’s what we called it back then, before we knew any better) at the Graduate Hospital of the University of Pennsylvania in Philadelphia. Back then I was taught to register patients using a very sophisticated IBM electric typewriter to complete a five-part, carbon-paper interleafed fact-sheet for each patient who presented. I was taught how to white-out any typos I may have made on each of the five separate pages. I remember driving home with blue-purple ink-stained fingertips each night.   

Where else but a hospital can one work for a single employer or company that employs as peers carpenters, chefs, nurses, businessmen and businesswomen, housekeepers, doctors, electricians, waitresses, and IT. All are professionals alike – all under the same roof, all dedicated to the same mission: saving lives, healing the sick, comforting those who suffer, and bringing new life into this utterly miraculous world. 

I consider it God’s work that gets done by the men and women working at our local hospitals in the service of others. Yes, nothing short of God’s work, literally escorting souls into and out of this earthly world. 

Now, as the churning storm we have come to know through our television screens as Hurricane Matthew approaches, the otherwise beautiful turquoise beaches of South Florida are darkening, just two hours away from landfall. And the beautiful, loyal, empathetic, and selfless men and women of Boca Raton Regional Hospital, along with the thousands of souls preparing at sister hospitals up and down the eastern U.S. seaboard, will go about doing just that over the next few days or weeks, if needed – God’s work..

About the Author

Rudy Braccili now serves as executive director of revenue cycle services at Boca Raton Regional Hospital, where he is accountable for the patient access, patient financial services, revenue integrity, health information management (HIM), and clinical documentation improvement program (CDIP) operations of a 400-bed acute-care regional academic teaching facility proudly affiliated with the Charles E. Schmidt College of Medicine at Florida Atlantic University.

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Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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