Page 152 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

150 Chapter 7
Abstract
Context: During the Ebola outbreak in West Africa in 2014-2015, close cooper- ation between the curative sector and public health sector in the Netherlands was necessary for timely identification, referral and investigation of patients with suspected Ebola virus disease (EVD).
Objective: In this study, we evaluated experiences in preparedness among stakeholders of both curative and public health sectors to formulate recommen- dations for optimizing preparedness protocols. Timeliness of referred patients with suspected EVD was used as indicator for preparedness.
Design: In focus group sessions and semistructured interviews, experiences of curative and public health stakeholders about the regional and national process of preparedness and response were listed. Timeliness recordings of all referred suspected EVD patients (13) were collected from first date of illness until arrival in the referral academic hospital.
Results: Ebola preparedness was considered extensive compared to the risk of an actual patient, however necessary. Regional coordination varied between regions. More standardisation of regional preparation and operational guide- lines was requested, as well as nationally standardised contingency criteria, and the National Centre of Infectious Disease Control was expected to coordinate the development of these guidelines. For the timeliness of referred patients with suspected EVD, the median delay between first date of illness until triage was 2.0 days (range 0 -10 days), and between triage and arrival in the referral hospital, it was 5.0 hours (range 2 -7.5 hours). In none of these patients Ebola infection was confirmed.
Conclusions: Coordination between the public health sector and the curative sector needs improvement to reduce delay in patient management in emerging infectious diseases. Standardization of preparedness and response practices, through guidelines for institutional preparedness and blueprints for regional and national coordination, is necessary, as preparedness for emerging infec- tious diseases needs a multidisciplinary approach overarching both the public health sector and the curative sector.