Investing in technology and services is a crucial step for healthcare organizations that need to be ready for anything, including unfamiliar infectious diseases, says a CNO who speaks from experience.
Anthrax, SARS, Ebola. While they're frightening, and at times deadly, the likelihood of a patient presenting at a U.S healthcare facility with one of these diseases is low.
Yet, as we know from recent history, it's entirely possible.
"I don't think anyone can ever realize the kind of stress an organization is under when this type of event occurs," says Ronda McKay, DNP, RN, CNS, chief nursing officer and vice president of patient care at Community Hospital in Munster, IN, a 427-bed not-for-profit facility.
McKay speaks from experience. It's been just over a year since Community earned the distinction of caring for the first person in the U.S with a confirmed case of Middle Eastern Respiratory Syndrome. There have been only two confirmed cases of MERS in the U.S. The other one was in Florida.
Despite the virus being novel to the U.S., Community thwarted any further transmission and prevented widespread panic by creatively using existing technology to gather data and then carefully communicating it to public health authorities, staff members, and the public.
'Life as You Know it Will Change'
"The impact of the disease is one thing," says John Olmstead, MBA, RN, CNOR, FACHE, director of surgical and emergency services at Community. "The impact to the community emotionally and, frankly, businesswise, is the what-ifs." In other words, fear of the unknown can often be more infectious and do greater, more lasting damage than the disease itself.
"We're very up on infectious disease processes, and we do a great job of identifying those patients that are at risk for, whatever it may be, from its inception," says McKay.
Because the patient presented with flu-like symptoms, he was quickly placed on isolation precautions as is standard protocol. But the situation grew more complicated. Based on the patient's history—he had recently traveled to Saudi Arabia—the EMR triggered an alert for further testing to rule out the MERS virus.
"You go on along your happy day and all of a sudden you get a phone call that a patient is going to be tested for the MERS virus," McKay says. "And a lot of people in the organization were unsure of really what that was."
And for good reason. The virus has only been on the epidemiological scene since 2012 when it emerged in Saudi Arabia, and, according to the CDC, it's only been linked to countries in or near the Arabian Peninsula. In May 2014, the death rate for patients with the disease was 50%, though it has since dropped to about 30%, Olmstead says.
The fact that they were heading into unknown territory hit home when, during a conference call, McKay asked Indiana State Department of Health officials what would happen if the patient tested positive for the MERS virus.
"There was a pause on the phone call and [the] exact words were, 'Life as you know it will change,'" McKay says.
Strength in Numbers
Once the patient tested positive for MERS, hospital leadership knew they had to act quickly to minimize harm by determining who had been exposed to the patient while inside the hospital. "We started putting things in motion because what you have to consider is the patient, the patient's family, the other patients inside your organization, all your employees, and the community at large," McKay says.
This was no small task. Community is not a tiny hospital out in a cornfield. It's a 445-bed facility in the northwest portion of the state and is close enough to Chicago that it's considered part of the city's greater metropolitan area. As far as they knew, failure to contain the disease could wreak havoc both within the hospital and across a large, highly populated geographic region.
Thanks to some creative thinking, they realized they could pinpoint which employees had been exposed to the patient by using reports generated from the EMR, the real-time locating system on the employee badges, and security camera video footage.
"In maybe 40 minutes, we knew through our videotape exactly where that patient had been—the waiting room, hallways, room—and every staff member that had been in that room," Olmstead says.
The 50 employees that had direct exposure to the patient were placed on furloughs until it was determined they had not contracted the virus.
The security footage was also used to establish which other patients or visitors had or had not been exposed to the patient while in the hospital which was a huge factor in reassuring the public.
"It became very apparent that we had things under control," McKay says.
Advice From Those Who Have Been There, Done That
The graceful way Community handled this event has not gone unnoticed. McKay says the hospital often gets requests to speak about the experience. She shared some pointers for nurse leaders:
- "This is going to sound simple, but you always need to stay prepared," McKay says. "You've got to make sure that your process flows are where they need to be to sustain an event."
- Clearly communicate those processes so your staff is educated and understands them, then test, and fine-tune the workflows through regular safety drills. If something doesn't work during a drill, address it promptly. It's far better to have a misstep during dress rehearsal than it is when you are thrust onstage under a national spotlight.
- McKay also recommends investing in technology and infrastructure to increase safety and quality of care. As Olmstead points out, none of the technology they used to determine exposure was created exclusively for MERS surveillance.
"If our driving force was, 'Gosh we need to make sure we do the best job we can when this one in a billion chance of a guy from Saudi Arabia coming over [with MERS] happens,' we wouldn't have invested all this technology," he says. "We invested in it to help patients. And it worked."
Get the Most Out of HIT
McKay makes another important point about technology—investing in it means more than just purchasing it. You need to know what you have, understand its capabilities, and ask how you can use it to maximize your current process. It's because they knew their technology systems so well that they were able to use the existing features to track the MERS exposure.
McKay recommends using the same individual to provide updates to the media and the public. "You have to send a consistent message," McKay explains. The more representatives that speak to the media, the more likely it is that they will contradict each other. This can make it seem like the hospital does not have a handle on the situation and that can create anxiety in the community.
Finally, when a crisis hits, it's important for nurse leaders to be visible and communicate with bedside staff says McKay.
"You can't just sit there in your dome and say, 'Bring me the information,'" Mckay says. "You need to keep in touch with what's really going on within your organization."
McKay sums up what she learned from what she hopes was a once-in-a-lifetime event: "I think that you need to prepare for the unpredictable, invest in technology and services for your organization, and invest in education and collaboration of your employees."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.