It was the night of July 20, 2012 and Paige Patterson didn’t really grasp the magnitude of what had happened until she pulled up to the hospital in the wee hours of the morning.
It was there, at the University of Colorado Hospital (UCH) in Aurora, that Patterson, a hospital manager and capacity software liaison at UCH Aurora, saw nurses running from their parked cars into the emergency department (ED). Once she saw that and got to the command center, where she was greeted by hospital executives and directors, it was clear that this was bigger than she had originally thought when she was asked to come in at 2:07 a.m. The state of many of the victims in the ED only confirmed that.
“Some of the physicians equated it with a war zone battle triage situation. Those of us that have never been in that situation, it certainly felt like that. Patients were triaging themselves to the waiting room, because they could look around and see someone who is more critical than they were,” Patterson said to Healthcare Informatics in an interview at the 2014 Healthcare Information and Management Systems Society (HIMSS) Conference.
Of course, “what happened” is being legally determined in a court room in Colorado. By most accounts, an alleged suspect by name of James Holmes walked into a movie theater in the Denver suburb that night and opened fire with automatic weapons during a midnight screening of “The Dark Knight Rises.” Twelve people were killed and 58 were injured.
Being Ready During the Unthinkable
UCH Aurora, a 551-bed medical and surgical facility, is a mere 3.5 miles from that movie theater. Immediately it took on a large number of the victims. By 1:15, Patterson says, the ambulance bay was full. One woman who suffered minor injuries even ran to the hospital from the movie theater. In total, they brought in 22 people for treatment and one person who was dead on arrival.
UCH Aurora Credit: UCH Aurora
As soon as chatter began on the police radio, not long after Holmes allegedly opened fire, the hospital went into disaster readiness and response mode. Thanks to post 9/11 regulations from the Federal Emergency Management Agency (FEMA), an incident command structure with training protocols was already in place. Further, when the Democratic National Convention came to Denver in 2008, the hospital’s leadership doubled up on its preparation efforts for any kind of mass shooting.
Yet, Patterson, who used to work in the airline industry, says it’s a similar situation in that this kind of organizational structure never actually prepares you for the real thing. Multiple patients had to move around the hospital from department to department. This was done not only for them to undergo life-saving procedures and tests, but just as a matter of space.
“On that night, we were on divert since 7 p.m. We had patients in our ED boarding because we had no beds for them. That was our norm for two-and-a-half years,” says Patterson, who was positioned in the command center to provide information on the patients and keep track of where they were in the hospital.
Automated Capacity Management System
Figuring out this tracking information was vital. It would allow practitioners to focus primarily on saving people’s lives in an extremely time-sensitive situation. This is where the hospital’s automated capacity software system came in handy.
UCH Aurora interfaced a capacity system from the Pittsburgh-based TeleTracking with the hospital’s enterprise-wide electronic medical record (EMR) from the Verona, Wisc.-based Epic Systems. This allowed Patterson to track the patients throughout their stay; not only in terms of location within the hospital, but with vital demographics, physician information, length-of-stay, and their diagnosis as well.
“By designating each of these patients as a ‘disaster patient,’ with that attribute I could pull a report. Instantaneously I had everybody’s name, I pulled their demographics, and I had access to their diagnosis within (the system). So I cut and pasted (the information from TeleTracking) into a spreadsheet that information which wasn’t there,” Patterson said.
That spreadsheet allowed Patterson to track the patients throughout their stay with all of that information—primarily where they were and where they had to go next. It helped them relay information to the City of Aurora or to the hospital’s chief information officer to possibly protect patients from the media.
Using the capacity system information and that spreadsheet, “helped coordinate efforts (around the hospital),” Patterson said. It tracked in-house patients that could be moved from the intensive care unit (ICU) to the post-anesthesia care unit (PACU), which needed to be filled for those capacity reasons. There were other in-house patients that the system revealed could, and had to, be discharged early on Friday morning, to make room for the more critical patients.
“The patients who knew they could go home, were watching the news, and said, ‘Send me home. You have other things on your mind.’ It was a community effort to make this happen,” Patterson said.
It truly was an all hands on deck ordeal that night, Patterson recalled. The CEO of the hospital was the incident commander, the chief nursing officer was the operational commander, and in total, approximately 120 people reported to the hospital in the wee hours of the morning. More workers would join them a few hours later. Over time, the efforts of everyone would shine through as all 22 people who came into UCH Aurora alive that night were still alive when they later left.
“Having worked at the hospital for as long as I have, I had confidence in our physicians in our emergency department that they could do what needed to be done. We were the experts in our field. If we couldn't do it, who could? What I was more concerned about was how it would come together. But I knew the people who were in place were the right people at the right time,” Patterson said.
