Now that Ebola virus disease (EVD) has spread to the United States, ambulatory and urgent care centers must be prepared to encounter and rule out suspected cases.
While most patients who suspect they might have EVD head to an emergency department (ED), a few are opting for urgent care. A Dallas County deputy sheriff
who fell ill after entering Ebola patient Eric Duncan’s apartment caused a stir by presenting to a local urgent care center. And on Oct. 12, a Boston-area urgent care center shut down
briefly while ruling out a potential case involving a traveler.
Defining Urgent Care’s Role
Unfortunately, while many people view their local urgent care center as a de facto ED, the reality is quite different. Unlike EDs, urgent care centers are designed to treat relatively minor illnesses and injuries. They certainly aren’t equipped to treat or rule out EVD. The best they can do is speed the person to the appropriate level of care while minimizing the risk to providers, staff and patients.
Even these tasks can be problematic. Many urgent care centers are stand-alone facilities that lack on-site access to appropriate isolation rooms. What’s more, urgent care triage is often handled by non-licensed personnel such as medical assistants and receptionists.
One important thing urgent care centers can
do is to assist potential EVD patients in reaching the appropriate level of care. This is especially true of centers that are part of a well-integrated Acute Care Continuum that encompasses emergency medical services, emergency care and inpatient care. Some, like many of CEP America’s urgent care centers, have the advantage of an existing multi-specialty network. However, as the Urgent Care Association of America (UCAOA) pointed out in a recent training webinar
, all centers can prepare by strengthening their communication with local hospitals, health departments and community resources.
In a recent email to 6,400 centers across the country
, UCAOA urged its members to take the lead in directing suspected EVD cases to hospitals. Here’s how CEP America is working with providers and non-licensed staff to meet that challenge.
To meet UCAOA’s charge, all urgent care centers must have an action plan in place before a potential EVD case calls or walks through the door. Of course, it’s impossible to formulate a single "master" plan, because each practice has unique needs. It's therefore essential that all practices have access to high-quality information, contacts and tools to aid the planning process.
Fortunately, many excellent resources are available. In addition to the guidelines
issued by the Centers for Disease Control, UCAOA’s website
contains a wealth of urgent care-specific training and content.
As a large, multi-specialty practice, CEP America also has access to a wealth of real-life experience from administrators, providers and nurses who have participated in EVD "rule outs." While most of these occur within emergency department and hospital settings, CEP America is incorporating many "lessons learned" into the training of urgent care personnel. It’s been exciting to see how operating as an Acute Care Continuum allows for the quick dissemination of knowledge.
Empowering Front Line Personnel
At CEP America, we believe that non-licensed urgent care personnel can play a key role in speeding potential EVD patients to an appropriate setting. By involving our receptionists and medical assistants in the triage process, we can do the right thing for these patients while minimizing care interruptions for all patients.
Here are a few of the strategies we’re using:
- Enable effective screening. All urgent care personnel are trained to screen for potential EVD cases using a simple algorithm. This screening is used both in-person and on the phone.
- Collaboration with local EMS. When a patient screens positive by phone, urgent care personnel contact EMS directly to arrange a safe transfer to an appropriate facility. This allows ambulance personnel to prepare the vehicle and personnel and to alert the receiving facility.
- Encourage patient self-identification. Centers display posters urging patients to alert staff if their travel history or symptoms could indicate EVD.
- Focus on isolation and transfer, not treatment. To minimize contamination, patients who screen positive are "isolated" in a treatment room. In-person contact with stable patients is limited. Instead, staff works directly with EMS to arrange a transfer.
- Gear up. All centers receive instruction in the stocking and use of personal protection equipment.
- Share learning. CEP America personnel who participate in real-life EVD rule-outs are encouraged to share their experiences and lessons learned through CEP America’s intranet, internal communications and professional forums. Practice management consultants also help disseminate innovations and best practices across hospitals and clinics.
Is It Possible for Urgent Care to Over-Prepare?
The business cost of EVD preparation is a concern for many urgent care centers. At present, the chances of encountering a real case in this setting is extremely remote. Given these odds, centers may question whether empowering non-licensed personnel to screen and divert patients is worth the potential loss of business.
At CEP America, we’ve decided that preparing thoroughly not only makes good business sense, it’s the best thing for our patients and personnel. On the business front, the cost of losing a few patients pales in comparison to the cost of shutting down the center entirely for an EVD "rule out." And given the high level of concern among our patients and personnel, preparedness inspires confidence and provides reassurance. In addition, preparation would greatly enhance our effectiveness in the remote chance that EVD becomes more widespread.