Nursing Institute Geared Up for the RNC

Approximately 50,000 people traveled to Cleveland for the Republican National Convention (RNC) held July 18 – 21, 2016. The high-profile event temporarily increased the city’s population by 13 percent and brought with it the potential for security risks. Much like the city itself, Cleveland Clinic prepared for the RNC. Nursing leaders were instrumental in helping the healthcare system create a plan to handle a variety of “what if” scenarios, including an upsurge in emergency department visits.

Staffing allocation key to planning

A year before the RNC, a multidisciplinary team began looking at how Cleveland Clinic would manage care for its normal patients, as well as a few extra hundred or thousand people. The group included representatives from surgical services, the emergency department, facilities, supply chain, communications, nursing and more. Two people on that team, who also spearheaded the Nursing Institute plan for the RNC, were James Bryant, DNP, RN, NEA-BC, ACNO of Emergency Medicine, and Sheila Miller, DNP, MBA, RN, CNO of Cleveland Clinic’s South Pointe Hospital.

Sheila Miller, DNP, MBA, RN

“We planned what we would need to have in place for 96 hours – the time it could take the government to get you help in case of an emergency [for example after a flood or hurricane] – for our normal patients and those that could be here as part of the RNC,” says Bryant.

Miller admits that initially the planning task seemed daunting. “There was a fair amount of angst around what could happen and how you even begin to tease out a plan,” she says. “We ended up thinking about two distinct possible situations.” The first was an increase in patients due to the sheer number of people who would be in Cleveland that week. The second was related to a potential event, such as extensive rioting or an attack by terrorists.

One of the top considerations for either situation was staffing. “We needed a plan to get the right people in place, train those who would be most likely impacted, then make sure we had enough staff on duty or ready if called,” says Miller. The Nursing Institute provided staffing templates, developed by the Emergency Management Team, for each unit at Cleveland Clinic’s main campus, nine regional hospitals and numerous family health and surgery centers throughout Northeast Ohio. The template included spaces for a complete staff roster with contact information, a list of the unit’s specialties, the number of private and isolation rooms on the unit and other critical information. Once completed, all of the templates were compiled in a manual that was distributed to every unit and placed on an encrypted drive for all CNOs.

“We anticipated an increased risk during the RNC, and that gave us the opportunity – and the responsibility – to look at things a bit differently,” says Miller. “We adopted a coordinated approach so that resources could be planned for and shared throughout the healthcare system.”

James Bryant, DNP, RN, NEA-BC, ANCO

Staffing during the week of the RNC varied by unit. The Nursing Institute put a policy in place disallowing leadership from taking vacations and limiting vacations for caregivers. Hospitals closest to Quicken Loans Arena and downtown, including Cleveland Clinic’s Lutheran Hospital and main campus, augmented staff in certain areas. For instance, the emergency department at main campus increased staff by 20 percent. Some ORs staffed up while others did not, realizing that if an event occurred all elective surgeries would be cancelled, and that workforce could be utilized for emergency surgeries.

“It wasn’t one-size-fits-all,” says Miller. “We’re obligated to not only provide safe, quality care. We’re also obligated to be good stewards of resources. We had to be thoughtful about where the risk could be and how we match resources to the risk so we would have them available if something should happen.”

Extension of Code Yellow

At first glance, preparing for a possible event seemed challenging because the variety of scenarios, from chemical, biological, radiological and nuclear, food borne illness to a mass shooting. As its starting point, Cleveland Clinic used procedures already in place. “We have a good disaster plan – a Code Yellow plan – and we built off of that,” says Bryant. “It’s now something we can deploy at any time.” For the RNC, 165 departments developed these plans to a higher capacity as well as enhanced additional plans such as Hospital Emergency Response Teams with 406 decontamination team members and a 150 person Clinical Strike Team that would deploy anywhere needed in the Cleveland area to support a hospital in a surge situation.

Here are a few of the changes the healthcare system made to its Code Yellow for the RNC:

• Staff monitoring – “The Staffing Office did ongoing assessments and knew where our resources were, so if something occurred we knew how to mobilize quickly,” says Miller.
• Communication technology – The Nursing Institute planned to use Send Word Now, its mass notification system, to page RNs in case of an event. CNOs across the healthcare system also instituted twice-daily calls during the RNC to discuss what they had seen in the previous 12 hours and what they anticipated during the next 12 hours. “It was a way for all of our nursing executives to know what was going on everywhere so they could make plans for individual locations,” says Bryant.
• Space reallocation – If extra beds were required, main campus and other Cleveland Clinic hospitals identified areas that could become makeshift patient rooms. These included procedural areas, such as endoscopy and bronchoscopy. The floor-by-floor plan identified 1,000 potential beds.
• Overflow facility – If a large event led to more casualties than the hospital could accommodate, the healthcare system planned to use the ballroom in the InterContinental Hotel Cleveland on main campus. The blueprint included 150 beds, nursing stations, a pharmacy, supply areas and more.
• Extra training – Key personnel received training on everything from evacuating main campus to decontaminating patients in a radiation attack. Cindy Willis, DNP, MBA, RN, CMSRN, Senior Director of Nursing Education, led simulation training at all of Cleveland Clinic’s emergency departments. She programmed a simulation mannequin to resemble a blast injury victim, then taught healthcare personnel how to perform tasks such as applying tourniquets and using quick clotting agents.
• Supply stocking – Cleveland Clinic stockpiled 96 hours’ worth of medical supplies in a building on main campus and lined up sources for more supplies, if necessary.

A Quiet Week

When the convention attendees came to town in July, nursing leadership felt prepared. “It’s impossible to plan for everything,” says Bryant. “But it was important to have a generalized approach and then know how to modify it on the fly.”

Thankfully, everything went smoothly. Bryant says Cleveland Clinic treated fewer than 100 patients directly related to the RNC, although they did see an increase in car accidents and alcohol-related incidents. There was only one medical emergency – an anaphylactic reaction. The patient was treated by the Events Medicine team at Quicken Loans Arena, then transferred for additional care.

Though many components of the plan were never put into play, nursing leadership says the work involved in creating it was not wasted. Concludes Miller, “Having that structure ready to go instead of panicking if something happens and losing time in a critical situation – that’s valuable.”