Selected article for: "admission testing and low traffic"

Author: Fairley, Jessica K.; Kozarsky, Phyllis E.; Kraft, Colleen S.; Guarner, Jeannette; Steinberg, James P.; Anderson, Evan; Jacob, Jesse T.; Meloy, Patrick; Gillespie, Darria; Espinoza, Tamara R.; Isakov, Alexander; Vanairsdale, Sharon; Baker, Esther; Wu, Henry M.
Title: Ebola or Not? Evaluating the Ill Traveler From Ebola-Affected Countries in West Africa
  • Document date: 2016_1_18
  • ID: z1gw338y_24
    Snippet: Although Emory's ETU and experience in managing patients with confirmed EVD were critical in the development of our procedures, we believe that there are numerous lessons learned that can be helpful for other institutions as they review their preparedness. We found that most PUI in our series had low suspicion for EVD and could be managed without admission to our ETU or testing for Ebola virus. Other Ebola assessment centers are advised to work c.....
    Document: Although Emory's ETU and experience in managing patients with confirmed EVD were critical in the development of our procedures, we believe that there are numerous lessons learned that can be helpful for other institutions as they review their preparedness. We found that most PUI in our series had low suspicion for EVD and could be managed without admission to our ETU or testing for Ebola virus. Other Ebola assessment centers are advised to work closely with their local health departments and institutional laboratory personnel to determine their approach when evaluating PUI for EVD [25] , with particular attention to Ebola virus testing and other tests needed for the timely diagnosis of other potentially life-threatening infections. Because PUI may present unexpectedly at numerous clinical sites, we found that screening at all potential sites of patient intake was critical, including the screening of outpatients over the phone when appointments are scheduled. Precautions to minimize visibility of PUI (eg, using an alternative, low traffic entry point to the tropical medicine clinic) were important to protect patient privacy, especially because the level of PPE used may attract excessive attention from patients and staff. Evaluation of PUI in the clinic and ED was time and resource consuming in numerous ways. In addition to enhanced PPE, our protocols required dedicated staffing for each PUI at numbers beyond what is routine in the clinic or ED, and each evaluation typically required several hours total, from the time of triage to final disposition. Because PUI are restricted from using public means of transportation, the transport of PUI also presented challenges when patients lacked personal means of transport. In this situation, close collaboration with the local health department was needed to arrange for ambulance transport using appropriate precautions. Regular practice drills and tabletop exercises were important to train staff and identify gaps in our procedures. Although our procedures presumably incurred significant direct and indirect costs for our healthcare system, we believe that the high consequences of EVD warranted a specialized plan for PUI.

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