The companywide information system failure at Sutter Health last week is raising concerns among some nurses and at least one patient about how the health-care giant functioned amid the crisis.
In a video message to Sutter Health employees, Sutter Chief Executive Officer Sarah Krevans complimented the patience, thoroughness, commitment, compassion and resilience of employees, saying "all of this helped to ensure the continuity of high-quality, safe patient care."
"We will be reviewing every aspect of this event and taking seriously every recommendation for improvement," she said. "I also want to hear from all of you. I want to know what happened where you work."
She could be hearing some criticism based on the comments of two nurses at Sutter Medical Center, who both spoke to The Bee on condition of anonymity, out of fear of reprisal by their employer. They expressed concerns that some patients were admitted Tuesday, after the systems failure, despite gaps in hospital resources and despite the absence of critical patient information. For instance, a surgical nurse said, the surgical team relies upon computer access to a history and physical done within the previous 30 days and certified by the physician as still being valid on the date of surgery.
While patients were arriving with their histories and physicals on paper, the nurse said, the documents didn't include the doctor's certification that the patient’s condition hadn't changed. If something had gone wrong in an elective surgery, the nurse said, the medical team would have relied on those documents to assess the cause.
"Other Sutter hospitals canceled elective surgeries," the nurse said. "Why did Sutter Medical Center feel like they needed to do elective surgeries?”
There was also at least one instance Tuesday, the nurse said, when a surgeon needed instruments not stored in the operating room.
The operating-room telephones normally display a directory of numbers to supply rooms or nurse stations, the surgical nurse said, but because that was inaccessible, a nurse had to scramble from the room to get the instruments the surgeon needed.
The surgical team normally tries not to leave the operating room because a patient's condition can deteriorate in seconds, the nurse said.
In addition, a neonatal nurse told The Bee that Sutter's downtown facility was still accepting transports into its neonatal ICU, "even though they don’t have the resources to handle it while dealing with all computer systems down.”
In response, Sutter Medical Center administrator Rick Harrell said that, because of the system failure, the center at some point on Tuesday suspended accepting new patients in all units until the staff could assess whether they had the capacity to safely care for patients checked into the hospital.
Once they did so, the administrators relied upon nurses in each department to determine whether they had the ability to take in more patients. If neonatal opened back up for patients, he said, it was because there were enough nurses to handle the patient load.
Even in routine situations, said Harrell, the assistant administrator for surgical services at Sutter Medical Center, management checks in with surgeons to assess whether upcoming procedures can go on as scheduled, and they did that same evaluation with surgeons as they considered the 50 or so elective surgeries scheduled for Tuesday.
In the end, he said, surgeons said they felt comfortable they had the film and paperwork they needed to proceed with all but 12 procedures. Although nurses may not have been able to find documents, Harrell said, all the necessary approvals from physicians were obtained before any elective surgeries.
Harrell emphasized that Sutter employees train regularly on how to handle disasters to ensure they have effective protocols.
"We test for disaster internally, including our information systems, as well as we do it with other hospitals regionally, with the EMS employees, etc.," he said. "We’re prepared to support the community safely 24 hours a day, 365 days a year.”
If any member of the medical team is uncomfortable with an assignment, he said, that individual should voice the concerns. In fact, he said, the licensing for all medical professionals requires them to report their concerns.
Also, Harrell said, each surgical team pauses to check in before each operation to review the plans for any procedures, determine whether the right equipment is available and whether everyone in the team feels prepared to go. But the surgical nurse said that because this safety pause occurs after the patient is already anesthetized and the team is assembled around them for surgery, it puts nurses in the awkward position of shutting down procedures already in progress.
Nurses shouldn’t have to wait for a chance to disclose concerns when the surgeon is ready to pick up the knife and go, the nurse said, adding that recent nurse graduates have trouble asserting themselves with experienced surgeons.
While administrators asked physicians to assess whether they had what they needed in advance of performing the elective surgeries, the nurse said, nurses weren't asked. What the surgeons do normally doesn’t change, the nurse said, but a disaster like this one significantly changes the practices for nurses.
The surgical nurse was not aware of any Sutter Medical Center nurses getting to assess or report on the environment, the impact of changes in process or even their comfort level ahead of the administration’s decision to schedule elective surgeries.
Regarding the phone system, Harrell said that Sutter Medical Center has a backup phone system in place for emergencies, and the operating-room phones could have been used to call the operator or any nurse station for assistance.
One takeaway from this experience, he said, might be training staff to trust that the backup system will work. The hospital brought in extra staff to check in on operating rooms. Harrell said his staff at Sutter Medical Center tried to reach each patient whose procedures or tests were canceled to alert them to the cancellations in advance.
Auburn-area resident Gina Mendenhall, who works as a health-care advocate for other people, said she received no warning from her doctor's office or Sutter lab in Roseville. Mendenhall said she was scheduled for a six-week post-operative evaluation at 10 a.m. Tuesday by her doctor, but when she arrived an hour early as told for X-rays on the Sutter Roseville campus, she found herself in a waiting room with about 20 other people.
And, like her, many of them were not able to get X-rays done because their referrals were inaccessible due to the computer crash, she said.
"I saw so many older folks ... that were on oxygen and really struggling to make their appointments, only to be told, 'There's nothing we can do without being able to access your health records,'" Mendenhall said. "It's hard to believe that there was absolutely no backup. I'm happy it didn’t happen while I was in the hospital, as the nurses won’t even give you a Tylenol if the computer doesn’t say it’s OK."
Mendenhall said she and her husband, who took the day off to drive her, had to walk from the X-ray department to her doctor’s office to see whether she could get a referral, because the phone system was down, but when she arrived, her specialist wasn't there. The office staff told her all appointments had been canceled and they would not be able to reschedule her until computers were back up.
Krevans said that despite all of the company's planning, protocols, investment in technology and emergency systems, Sutter Health was not able to provide the clinical support that was needed.
"That was not acceptable," she said. "I am disappointed that this event meant we couldn't meet all the needs of those we are privileged to care for, that we were unable to do everything that we wanted to do for our patients and their families."
Harrell said that, at Sutter Medical Center, contact information and necessary paperwork were available for most patients scheduled to come in for procedures.
"We saw hundreds of patients in the hospital ... just like we normally would," Harrell said, "and we put additional procedures in place to ensure our patients were safe. I really cannot speak to that one patient’s experience, but I can say there was an effort made to communicate after we spoke with the physicians, and if the decision was made to change the patient scheduled, we made every attempt to reach the patient before they arrived."