Prescription for Change

Hospital preparedness for Ebola: 5 lessons so far

by Julie Riley

At every hospital and health system in the nation, leaders are scrambling to ensure their teams are prepared for Ebola. In response, our research team has launched a new project, including interviews and a survey, to surface specific challenges and emerging solutions. Here are five early findings:

1. Not every facility will likely need to treat confirmed Ebola patients

In most regions and systems, specific facilities are beginning to be designated as destinations for confirmed Ebola patients. This allows for a more targeted approach to allocating resources and training. For example, Novant Health has designated three regional facilities where patients with Ebola will be transferred. Novant’s plan establishes an eight-bed, locked ICU unit to care for confirmed patients.

Similarly, Bellevue Hospital will accept high-probability and confirmed cases from other public hospitals in New York. Bellevue has four single-bed isolation rooms in an infectious disease ward, and is setting up a distinct laboratory within the ward to handle lab specimens from Ebola patients to reduce the risks from transporting confirmed lab specimens during treatment.

2. Every facility must be prepared to screen, isolate, and transfer patients

Staff should be prepared to screen 100% of patients. Both the CDC and local public health departments have created "Ebola Algorithms"—screening tools to help frontline staff identify and triage suspected patients, based on whether they are high or low risk. (Here are some examples from North Carolina, New York, and CDC.)

The CDC has also provided protocols for the safe management of suspected Ebola patients. Granted, clinicians on the ground have questions about some elements of these protocols; the CDC is reportedly working to update and improve them right now. But all staff should be prepared to use existing protocols as a starting place.

3. Hands-on training is a must

In testimony to Congress, Dr. Vargas, Chief Clinical Officer of Texas Presbyterian noted, "Communication is critical, but it is no substitute for training." Once you've created appropriate screening, diagnostic, and isolation protocols for patients, the critical next step is to provide staff with live training and practice to ensure they can execute.

Texas Presbyterian now conducts face-to-face training with all staff to ensure they understand and can execute the screening protocol, and that they can effectively use personal protective equipment (PPE) while interacting with suspected Ebola patients. To reach every single staff member, training sessions were run at the start of every shift for several days. The hospital also provides ongoing regular ED refresher courses for nurses.

4. Test your readiness

After your staff is equipped with the training and tools to screen patients, provide an opportunity to practice with drills and “secret shopper” tests. For example, South Carolina’s Department of Health and Environmental Control has conducted undercover drills to ensure their ER and outpatient clinics are able to identify all suspected patients. And Hennepin County Medical Center in Minneapolis (which has a large community of Liberians) is conducting regular drills with fake patients and ensuring every part of their protocol is executed flawlessly.

5. Don't go it alone

It takes collaboration with the local public health department, other facilities, and the broader community to be fully prepared. For example, waste from confirmed Ebola patients requires special hazardous materials training, which was a reported problem for Emory University Hospital in Atlanta. While Emory solved the problem by autoclaving all waste prior to disposal, this may not be an option for all hospitals, so planning ahead is critical. Similar planning and partnerships will be required to ensure adequate transportation for suspected patients, and transportation and testing of lab specimens to confirm diagnosis.

Additionally, working with community partners can help proactively identify suspected patients early. Consider that those traveling to and from infected regions may not have insurance, so assuring the community that all patients will be treated, regardless of their immigration status or ability to pay, can help identify patients at earlier stages of the disease. For example, New York is distributing this "Am I At Risk" brochure (in both English and French) to encourage patients at high risk to seek treatment early.

We'd love to hear from you

Our team would love to hear from you on this topic. What are you finding to be the most difficult elements of preparedness? Do you have resources you'd like to share with your colleagues at other institutions? Send me an email at rileyju@advisory.com.