Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
Travel and Communicable Disease Screening
DUHS Infection Control TeamDesign/Pilot
SBAR
• Situation – DUHS is not actively completing travel and exposure screening
• Background – Initiated travel screening for Ebola per CDC recommendation but discontinued due to limitations in electronic medical record (Maestro Care)
• Assessment – with recent Maestro Care Upgrade we have the usability and functionality that is needed
• Recommendation – Implement travel and exposure screening tool initially in the ED and eventual planned roll out across DUHS
Syndromic Surveillance Survey Results
Bonnie Taylor, MPH, BSN, RNIbukun Akinboyo, MD
What type of practice environment do you work in?
10/25/2019 4
Do you have a method for screening patients who may have an infectious disease?
10/25/2019 5
60%
Of those who responded “Yes”,106 specifically identified who is
conducting the screening:
PRMO 65%
Intake/Triage 23%
Scheduling 8%
Self‐Identification Prompted by Signage
4% 40%
40% said “Yes”
Of those who articulated their method of screening, 82 identified these systems in place:
Triage by Clinical Staff 29%
PRMO/Mask – Waiting Room 28%
PRMO/Asks Questions or Sees Symptoms
23%
PRMO/Travel Screen, Sees “Flag” in System
12%
TB Screening Tool by Clinical Staff 6%
Who could be responsible for asking patients screening questions?
10/25/2019 6
What is the best method to communicate with clinical staff about a potentially infectious patient checking in?
10/25/2019 7
77% identified that verbal communication (either face‐to‐face or via telephone) is the most reliable method to notify clinical staff.
Are there any barriers to rapidly identifying and isolating patients who may have a highly transmissible infection?
8
41% said “Yes”
Of 306 responses reviewed, barriersidentified include:
Personnel knowledge or skill 32%
Space 26%
Patient knowledge or privacy 16%
Resources, equipment or tools 13%
Time 9%
Other (Don’t know, unsure etc.) 3%
Can these barriers be overcome?
Tell us why you think these barriers can or cannot be overcome.
10/25/2019 9
74% said “Yes”
Of 191 responses reviewed, barriers identified include:
Personnel knowledge or skill 46%Space 30%Staffing 6%Communication 18%
Comments:• Better training and awareness• Need written protocols• No space to isolate• Need immediate access to interpreters• Add signage to educate patients
Summary
• Intake staff appear to have clear and primary limited roles in identifying potentially infectious patient
• Training, staffing and space are the most common perceived barriers
10/25/2019 10
ED Arrival Screen
Screening
Create BPA’s to notify clinicians
• Epic automatically updates our system with new CDC travel warnings, we will need to create the BestPractice Advisory ﴾BPA﴿ that shows those warnings to clinicians
• The BPA appears when information collected in the travel screening activity causes a patient to be flagged as potentially being infected by a contagious disease they contracted while traveling
Giving Users Access to travel screening in
Pilot:• ED Arrival workflows (PRMO and ED Staff)Pilot will last for 3 months – Design group will be pulled back together 6 weeks into pilot to see how things are going and review data.
How often must a travel screen be completed?
To avoid screening patients too frequently, the Travel Screening activity considers a patient's screening as complete if the patient was screened recently as part of a different encounter.• Midnight yesterday or 24 hours before the patient's admission, whichever is earliest.
Timeframe consideration: 1 weeks2 weeks3weeks
Screen Patients During e‐check In
• Patient‐entered questionnaires in MyChartand Welcome give you the opportunity to begin screening patients before they even arrive at the clinic.
Future State Considerations
Discussion/Comments