Isolating measles patients before they can hit the emergency department
LATE LAST YEAR, an ambulance brought a sick child to the emergency department at Montefiore Nyack Hospital in New York. Providers began evaluating the patient’s symptoms, including a pretty bad fever and rash, working to diagnose the unidentified viral syndrome—and soon, the team made an unfortunate discovery.
“It turned out to be measles,” said Dr. Jeffrey Rabrich, the hospital’s medical director for emergency medicine. “As a result of that, we had some exposure of people who happened to be in the emergency department at the same time.”
Measles cases, which in May hit their highest level nationwide since 1992, continue to tick upward, with five counties in the U.S. suffering from ongoing outbreaks. That includes Rockland County, N.Y., home of Montefiore Nyack. There have been at least 275 confirmed cases of measles in the county since the outbreak began last year, according to the Centers for Disease Control and Prevention.
That places a huge responsibility on local hospitals and clinics, with providers tasked with caring for measles patients while working to reduce exposure to the virus. Healthcare facilities are one of the most common points of exposure for measles, according to Dr. Matthew Zahn, chair of the Infectious Diseases Society of America’s public health committee. “Even casual contact in the same closed air space to a person potentially spreads that virus,” he said.
That has both medical and cost implications for the broader region.
Public health agencies in New York City spent nearly $400,000 on efforts to control a measles outbreak in 2013, according to a study published last year in JAMA Pediatrics. The measles outbreak in question involved 58 reported cases of measles.
To battle the problem, Rabrich had an idea: build a measles alert directly into Montefiore Nyack’s pre-hospital communication system, an IT system that enables emergency medical services to send patient data—including text, photo and video documentation— to the ED in real-time while en route to the hospital using an app.
Montefiore Nyack began using the IT system, developed by a company called Twiage, a year and a half ago.
With the measles outbreak in mind, Rabrich approached Twiage CEO John Hui about integrating a new feature that would prompt first responders to assess whether a patient exhibits measles symptoms in the ambulance—and just a few weeks later, Montefiore Nyack’s pre-hospital communication system went live with a new measles alert.
Now, once EMS identifies a likely measles case, they can deliver an alert about the potential infection directly to Montefiore Nyack’s charge nurse in the ED. Armed with this data, ED staff can arrange to transfer an incoming patient to the department’s isolation room as soon as the ambulance arrives.
Since its launch this past spring, the alert has already been activated a few times, Rabrich said.
Twiage has since reached out to other hospitals it contracts with to offer access to the measles alert, and about a half-dozen hospitals—including Good Samaritan Hospital, also based in Rockland County—have signed up for it to date, Hui said.
The project is one reason Hui was a finalist in the Heritage Provider Network’s Healthcare Innovation Awards this past spring, an annual awards ceremony the managed-care organization hosts in partnership with Modern Healthcare’s sister publication Crain’s New York Business to recognize innovators improving access to and quality of care in the New York metro area.
To continue to reduce risk, Zahn said, hospitals must also establish a plan of action for when a potential measles patient arrives—that can mean directing a patient to an isolation room like at Montefiore Nyack, waiting to see them at the end of the day, or even evaluating a patient outside the walls of the facility, away from closed air environments.
“To make sure that you avoid these inadvertent healthcare exposures to measles, there’s a lot of layers and a lot of different parts of a plan that need to be put together,” he said. ●