The outbreak of an infectious disease can bring terrible consequences to large numbers of people in a short period of time, and its impact on a health organization can be far reaching and significant. To be proactive, many organizations are taking steps to assess the risks and help their staff minimize those risks when presented with the possibility of an outbreak by having a hospital incident management plan.
Recently, here at Spectrum Health, we had a patient in the Emergency Department, or ED, with a travel history and symptoms consistent with Lassa fever, which is an acute and often fatal viral disease. This patient had been in an area of West Africa where the disease is endemic. Luckily, the patient had medical knowledge and shared his concerns with the ED staff who promptly notified the infectious disease physician. The serious contagious disease unit or SCDU coordinator responded immediately, with the infection prevention staff, to ensure appropriate personal protective equipment was utilized, and that the patient and ED staff were safe.
Our facility was successful in responding to our first infectious disease incident. At the same time, we identified some areas for improvement and learned some key lessons for future training exercises and real-life incidents that we would like to share.
1. Team Communication
As most people can relate, communication is always at the top of any after-incident list. As such, we believe conducting a timeout in the ED and an SCDU team huddle at the start of the incident activation, before transferring the patient to the unit, would help clarify roles and ensure everyone is at the same level of situational awareness. We feel these two preliminary steps would have decreased logistical confusion that continued to mount throughout the workflow process.
Another suggestion is to create a standard reporting sheet and communication chart in the anteroom to assist staff and support staff communication effectively about patient treatment. An example of this might be a guide for signal interpretation between the patient room and charting room. In our situation at Spectrum Health, we set up two separate rooms to treat the patient. The rooms were connected by technology so that our SCDU patient-care team could focus solely on the patient when they were in his/her room. Support staff in the secondary location completed documentation, which through the technology, was visible in the patient’s room.
2. Organization Notifications
Next, we think sending mass notifications to areas outside of the SCDU that might be affected would be incredibly important and time sensitive. For example, when we opened the unit, we needed to move all current patients in that space to another location within the organization. We did not communicate this information well with those other areas. As a result, they did not understand the need to facilitate a smooth transition.
To keep everyone at the hospital in the loop, we recommend developing a script for staff involved in the incident. The script would provide guidance on how to inform staff located outside the space about what is transpiring. A simple statement like “We have opened the SCDU to care for a person under investigation” provides enough information for staff and leadership to understand they may be impacted, but not too much information to break patient confidentiality. Also, take care to dispel any rumors. In our case, the patient shared information with his peers, which then exploded into a game of telephone — rife with inaccuracies.
3. Improving Staff and Unit Visibility
Due to how quickly infectious disease incidents can evolve, use of a standardized identification system would facilitate recognition of major roles within the unit. For example, creating stickers such as hot-zone boss, infection prevention, physician, Environmental Services and monitor-room technician, could reduce confusion and improve the efficiency of response. Likewise, to direct traffic and flow on the unit, clear signage would help direct incoming staff, support services and visitors.
4. Food Service Needs
Emergency situations are very taxing and resource heavy, and there is always a need to feed staff. Although staff members are allowed to leave the unit, typically they do not. As a result, creating a standard food order is a sure way to keep everyone fed and available for the patient. Also, ensuring that patient meal trays use paper products, instead of reusable dishes and utensils, prevents contamination through transference.
On the day this incident occurred, our staff was at about 50 percent of what we had determined was necessary for a full team. We immediately recognized the need to add staff, but we also identified a need to provide the command center with consistent visibility into the SCDU staffing schedule so they would be fully aware of the situation when a patient arrives. Even though we were understaffed, mass notification to the SCDU team worked well and our staff responded in a timely manner.
Overall, as the first time officially opening the unit to a patient with a potentially infectious disease, our team responded in an overwhelmingly positive manner. For me, as the director of emergency preparedness at Spectrum Health, I was pleased with the performance of the team which is a great tribute to the education and dedication of our staff and the coordinator.