Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Survey Results: Ebola Preparedness Efforts Highly Variable

12/2/2014 12:00:13 PM | 0 comments

Over the past few weeks, Perspectives has been asking readers to weigh in on how their facilities are preparing to treat real and potential cases of Ebola virus disease (EVD). Well, the answers are in, and here’s what administrators, providers and nurses from across the Acute Care Continuum had to say.

Question 1: What has your facility already done to prepare for Ebola? (Choose all that apply.)

  • Educated providers and first responders on symptoms
  • Established hospital-wide protocols for dealing with a patient who presents with symptoms
  • Form an incident command center to ensure access to appropriate resources and personnel
  • Provided hands-on training to don/doff personal protection equipment (PPE) 
And here are the results:


 
As you can see, most respondents say their hospitals are working to educate their ED and EMS teams. However, less than half report that their facilities are prepared to mount a coordinated and/or centralized response, and only 56 percent say care teams have received PPE training.
 
So how do the results of our informal poll compare with more rigorous surveys on the subject? Well, as it turns out, the results are quite similar. In a recent survey by the Association for Professionals in Infection Control and Epidemiology (APIC), only 6 percent of respondents rated their hospital as "well prepared" to care for an EVD patient. Fortunately, about 72 percent did indicate their hospitals were moderately prepared (rating their efforts a 3 or 4 on a five-point scale). And as with the Perspectives poll, about half the APIC respondents identified PPE training as an area of concern.
 
Larger concerns were raised in a survey conducted by National Nurses United, in which a large majority of respondents said they were not aware of a hospital-wide policy around the potential admission of EVD patients and that nurses had not received EVD education that allowed them to interact with presenters and ask questions.
 
So across all three surveys, we see a varying but significant number of administrators, providers, nurses and other hospital personnel who believe their facilities could be doing more to prepare for potential EVD cases. This could underscore the importance of not only preparing but also communicating preparedness actions effectively to the providers and nurses on the front lines. 

Question 2: Where will patients presenting with Ebola be evaluated? 

  • In the ED, in a negative pressure isolation room with an antechamber
  • In the ED, in a negative pressure isolation room without an antechamber
  • In the ED, in a room that is not negative pressure without an antechamber
  • On an inpatient unit in a negative pressure isolation room with an antechamber 
And here are the results. (Numbers indicate percentages, and may not add up to 100 due to rounding.)

So as we can see, there's no one strategy that's been adopted by most facilities. Several factors could account for that variability:
  • Facility type. For urgent care centers and community hospitals, which may lack a sophisticated isolation room, placing the patient in an empty room and closing the door may be the best option. Such isolation measures are acceptable under CDC guidelines so long as certain infection control precautions are taken and aerosol-generating procedures avoided.
  • Resources. Hospitals designated by their local governments as disaster response centers may have access to more sophisticated isolation equipment, such as portable isolation tents with antechambers.
  • Staffing. Team members exposed to a potential EVD patient must be isolated until that patient is cleared. In smaller EDs with single or limited coverage, this can cause care delays or disruptions until back-up providers arrive. In such cases, transferring potential EVD patients to inpatient isolation immediately preserves scarce resources.
  • Organizational culture. Using inpatient isolation facilities for potential EVD patients has advantages, but it also goes against the personal ethics of many ED providers. The decision is likely an easier one when hospital-wide protocols are in place and a strong, collaborative relationship exists between the ED and inpatient departments.
Finally, the evolving national response may also play a role in hospitals' preparedness efforts. Last month, the CDC indicated that future EVD cases might be routed to one of a handful of facilities where teams are highly trained and equipped to manage the disease.
 
This announcement may have lessened hospitals’ urgency to develop rigorous EVD preparedness plans as the focus shifts to screening and transfer. However, as Perspectives contributors Prentice Tom, MD, and Gregg Miller, MD, pointed out in a previous post, hospitals have little to lose — and much to gain — by over-preparing for potential EVD cases.

[Image credit: "Checking Personal Protective Equipment (PPE) in the fight against Ebola" by DFID - UK Department for International Development licensed under CC BY 2.0]


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