Page 160 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

158 Chapter 7
n=12), and delays from physician consultation until CID consultation varied be- tween 0 and 4 days (median 1 day, n=12). One patient did not consult a phys- ician, instead a caretaker consulted the PHS directly. Median total delay from first day of illness until consultation CID was 2 days (range 0-10 days). After de- cision for referral, it took 5.0 hours until ambulance arrival at the hospital (range 2.0-7.5 hours, n=12) (see Figures 2 and 3).
The EVD laboratory tests were negative for all patients, and alternative con- firmed diagnoses were malaria (n=7), bacterial sepsis (1), norovirus (1), and no diagnosis (4).
The results of the interviews and focus groups , as well as timeliness of referrals were presented at the final plenary meeting. After discussions, it was concluded that more centralized support is needed to guide regional coordi- nation and that a clear regional referral system is needed covering the whole country comprehensively. The value of exercises at regional level, both small and large-scale, was emphasized, using existing exercise structures and financial reserves. Developing national contingency guidelines for institutional prepared- ness was recommended, including regional coordination, roles, and responsibi- lities of stakeholders and criteria for up- and downscaling in crises. This would secure preparedness between the public health sector and the curative sector.
13 0
12 10 0 11 10
10 10
961 8 2*
721 643 5 0
424 310 233
1 0
0 2 4 6 8 10 12
Number of days
First date of illness - MD consultation
(days)
MD- consultation RIVM (days)
Figure 2. Delays first date of illness – MD consultation – CID/RIVM consultation (days) * Case no. 8 directly contacted public health service.
Case numer