Page 163 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan
P. 163

Ebola preparedness among the curative and the public health sector 161
tation (median 2 days, range 0-10 days). The median referral delay was also extensive (5.0 hours, in 10 out of 12 patients over 3 hours) and can be attrib- uted to the preparations needed for the ambulance and isolation facility in the academic hospital. Referral delays should be reduced, as the patient might be in need of acute medical care. Morgan et al describe a delay in care delivery and even 1 death in the United States because of EVD precautions (9). Regional multisectorial simulation exercises will lead to shorter referral delays. In addi- tion, a centralised ‘stand-by’ ambulance with an intensively trained, dedicated ambulance team should be considered, as distances and, therefore, traveling times are limited in the Netherlands.
In the WHO JEE-Tool, in order to assess one’s country capacity to prevent, detect, and rapidly respond to public health threats, R.2.4. indicator in emergen- cy response operation states ‘Case management procedures are implemented for IHR relevant hazards’ (4). Although our health professionals have achieved ‘case management, patient referral and transportation, and management and transport of potentially infectious patients according to guidelines and/or SOPs,’ in our opinion, quantitative indicators as timeliness of procedures are essential to evaluate the functioning of the response in reality. Finally, the question is which delays are relevant to evaluate preparedness for this infection with low incidence but high impact. Referral delay not only affects patients care, it also has public health relevance, as hectic situations around a patient in the public domain easily leads to media attention, and delayed response will harm the publics’ confidence in health authorities. As most of the patients with suspect- ed EVD actually proved to have malaria, short patient and doctor delay also is essential to install proper lifesaving treatment immediately. Furthermore, in patients with suspicion of a highly contagious disease (such as Ebola), referral delay hampers institution of prompt isolation precautions. Fort this reason we consider timeliness of referral to be a relevant indicator for defining prepar- edness. However, as this might be different for other diseases, indicators for preparedness need to be chosen per event.
A limitation of our study is the selection process of participants in the focus group sessions. This bias was attempted to be reduced by at random selection covering all geographic regions in the Netherlands, and including participants representing organizations that experienced handling a patient with suspected EVD. A potential selection bias might have occurred during the coding process, despite an analysing process by 3 independent researchers. To minimize this bias and to maximize the generalizability, results of this study were presented at a final plenary meeting. Nevertheless, outcomes of this study might not directly
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