Are Emergency Departments Prepared for Potentially Infectious Diseases?

September 14, 2017

Are Emergency Departments Prepared for Potentially Infectious Diseases?

  1. Jennifer L. Wiler, MD, MBA, FACEP

Surprise drills at New York City EDs demonstrated that most are prepared to take initial precautions for suspected serious respiratory infectious diseases.

  1. Jennifer L. Wiler, MD, MBA, FACEP

To assess preparedness for the ability to care for patients with potentially severe infectious diseases, the Centers for Disease Control and Prevention performed 95 unannounced “mystery drills” (staged to simulate measles or Middle East respiratory syndrome) in 49 emergency departments (EDs) in New York City in 2015–2016. Outcome measures were compliance with standard infection control measures (e.g., hand hygiene, appropriate use of personal protective equipment); association between screening interventions (e.g., travel screening) and use of infection control measures; and time from patient entry to triage, wearing a mask, and isolation. EDs “passed” the exercise if the test patient was identified as high risk for an infectious respiratory condition, given a mask, and isolated.

Overall, EDs passed 78% of drills; 39% of EDs failed at least one drill. Masking and isolation (critical actions) occurred commonly when travel history was obtained (88%) but not when it was omitted (21%). Median time from patient entry to masking was 1.5 minutes (range, 0–47) and from entry to isolation was 8.5 minutes (range, 1–57). Compliance with hand hygiene practices was 36%; compliance with use of personal protective equipment was 74%.

Comment

Most hospitals in this study performed well and seemed prepared to limit secondary exposure to potentially serious uncommon contagious respiratory diseases. However, no real conclusions can be drawn owing to the self-selection bias of the study methodology (EDs self-identified to participate). Regardless, EDs must continuously evaluate their preparedness for such patients. The article provides a link to a toolkit for conducting effective mystery drills.

Editor Disclosures at Time of Publication

  • Disclosures for Jennifer L. Wiler, MD, MBA, FACEP at time of publication Leadership positions in professional societies Colorado Medical Society (Member, Board of Directors)

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