Since March 2014, over 28,000 cases of Ebola Virus Disease (EVD) have been reported in West Africa, with over 11,000 deaths. During the domestic response, NYC screened a total of more than 5,000 travelers arriving in the U.S. from affected areas. To prepare for the potential of imported cases of EVD, rapid measures were taken to ensure EVD readiness at frontline NYC healthcare facilities including the implementation of monthly EVD ‘Mystery Patient Drills’ (MPDs). This study aimed to identify challenges to the rapid identification and isolation of potential EVD cases in NYC Emergency Departments (EDs) by analyzing After Action Reports (AARs) from the MPDs.
METHODS:
NYC Department of Health and Mental Hygiene provided guidance to hospitals for developing screening and isolation protocols at EDs to ensure rapid isolation of patients with highly communicable diseases. Based on those protocols, facilities conducted MPDs with an actor presenting to the ED with symptoms and travel history suggestive of EVD. The 55 hospitals participating in NYC’s Hospital Preparedness Program were invited to submit an AAR summarizing at least one drill conducted between October 2014-April 2015, which included observations on adherence to screening and isolation protocols, quantitative performance measures (time of: ED entry, triage, isolation and clinical evaluation) and an improvement plan. Summary statistics were generated for quantitative measures. Report narratives were reviewed, coded, extracted, and analyzed to determine strengths and challenges experienced.
RESULTS:
Forty-five NYC hospitals with acute care settings (ED, urgent care) submitted AARs; of these, 87% recorded all required time points. The median time from patient entry to isolation was 9 minutes and median time from isolation to evaluation was 14 minutes.
Recurrent themes in best practices included: consistent travel history screening, rapid implementation of appropriate infection control measures and compliance with internal notification and security protocols. Themes for improvement included: staff competency with donning and doffing of personal protective equipment, ready availability of isolation rooms, communication within the isolation rooms, and consistency in documentation between facilities.
CONCLUSIONS:
Unannounced ‘mystery patient’ drills can be a useful tool to identify healthcare facility level performance challenges and guide improvement planning for the screening and isolation of highly communicable diseases. Though the analysis was limited by lack of uniformity of exercise design and reporting, findings from this study will inform the development of a standardized MPD program.