In light of the Ebola outbreak: 3 considerations for hospitals dealing with infectious disease

The essential business and legal issues hospitals should consider in advance of handling a patient with Ebola or other major infectious disease

When highly contagious diseases emerge, spread and present in hospital settings, the first hurdle hospitals need to overcome is the ability to treat the disease from a clinical standpoint. Can the facility handle treating a patient with Ebola, for example, or do clinicians know what to do for a patient with MERS?

"For most hospitals, that's the easiest part — treating the individual patient," says Laura Seng, a partner of Barnes & Thornburg and vice chair of the firm's healthcare department.

After clearing that obstacle, however, hospitals need to be concerned with the business aspect of treating patients with a high-profile infectious disease. Atlanta-based Emory University Hospital's and Omaha-based Nebraska Medical Center experienced this with the current Ebola outbreak, and Community Hospital did as well when the MERS epidemic manifested in Munster, Ind.

Ms. Seng and Heather Delgado, a partner at Barnes & Thornburg and member of the healthcare department, helped Community Hospital officials through the legal and business aspects of treating the patient who had MERS earlier this year. They say the first step to handling a similar situation from a business standpoint is to have a comprehensive response plan already formulated.

Infection control personnel should clearly be involved in the initial planning, but it is important to bring in the CEO, the director of nursing, CMO and the communications director when constructing the initial plan. From there, the response team should address the following issues:

Communication

Internal and external communication clarity and consistency should be key points addressed in the response plan. For internal communication, it is important to provide staff members with information consistent to what is published by federal and state agencies like the Centers for Disease Control and Prevention or the state department of health, according to Ms. Seng.

Controlling communications to external parties, like the media, should also be part of the plan. "[The hospital will be] flooded with reporters, and you can't let that have a negative impact on the regular patient care process," says Ms. Seng. For example, Community Hospital officials designated a nearby parking lot for members of the media so they did not block access to the hospital or interrupt patient care.

Overall, the hospital needs to assure everyone in the community — employees included — of their safety. Patients need to feel comfortable coming into the hospital for normal services, and employees should feel safe coming to work. Ms. Seng recommends using local infection control physicians to speak with the media and provide a "local level of assurance to the community."

"Hearing messaging come from a state or federal agency is one thing, but to hear a local physician say 'this is safe' is better messaging for the local community," she says.

Additionally, hospitals can conduct organized media interviews within the physical hospital to show community members everything is business as usual.

Human resources and staffing

Human resources and staffing is one area that could be easily overlooked in these situations, but one that is critically important to include in a plan. Hospitals should develop policies for how staffing should be handled if an infectious disease presents itself unexpectedly.

"For the Ebola patients, Emory knew exactly when the patient was coming, so there was no staff exposure because the patient was brought in in isolation," says Ms. Seng. But with many infectious diseases, the patient is in the hospital when the diagnosis is made, leaving some healthcare workers potentially exposed.

If a healthcare worker is potentially exposed, the CDC generally recommends that the worker leave the hospital or wear masks or other protective gear at the hospital during the incubation period of the illness. This could mean many workers, especially nurses, may miss work because of a potential exposure.

Hospital officials should put a plan in place now for how to pay nurses or others who may need to stay home due to exposure. Whether it be paid, unpaid or paid vacation time, officials then need to explain the policy and reasoning to the staff.

Further, if some workers do need to stay home due to possible exposure, hospital officials should remain in constant contact with them. "Let the staff know you're concerned about employee health," Ms. Seng says. This includes checking in on affected staff daily and making a dedicated phone line available so employees can call in and update the organization on their health status and receive updates from the hospital's infection control staff.

HIPAA concerns

Treating a patient with a high-profile infectious disease raises a whole host of issues related to patient information and HIPAA.

For instance, employees are going to be curious if a high-profile case comes to their hospital, and many could be tempted to peek at the medical record of a MERS or Ebola patient. "This is a good time to start monitoring access of who is using the patient's medical record," says Ms. Delgado. "Remind them there are 'no peeking' policies in place and the consequences of going in and looking at the record."

To take things a step further, some EHRs have a "break the glass" feature, which makes people accessing certain records enter their credentials and give a reason for their access. Hospitals may consider implementing a similar feature if available to remove temptation.

Additionally, hospitals need to send a lot of information to various institutes, like the state health department or the CDC, when they treat a high profile infectious disease. Hospitals should ensure all information shared with agencies is encrypted and sent securely.

Even though a hospital's brush with a high-profile infectious disease is rarely foreseeable, it is best to be prepared. Every hospital should have a response plan in place that hits on these key points and is easily mobilized at a moment's notice.

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