The Home Game: Ebola Response and Recovery at a Dallas Hospital Seema Yasmin, MD

A far away problem…

…but not too far

Mathematical models predicted imported cases

Level of preparedness dictates recovery

Who was prepared?

6

6 7

6 7 5

The hospital “…the Neiman Marcus of hospitals.” 75,000 patients a year Daily census average: 428 patients

The hospital during the Ebola response Revenue dropped $8.1 million or 25.6% during first 20 days of October ER visits declined by 2,336 or 53.3% Surgeries declined by 165 cases or 25% Daily census declined by 21.1%

The hospital in October Revenue declined $12.2 million or 24.7% ER visits were down 25.3% Surgeries declined 23.5%

The hospital in November Revenue declined $8 million or 17.1% for a total of $20.3 million over the two months ER visits were down 26% Surgeries declined 14.7

Gaps in preparedness

Exercises Practice everything Growing body of evidence showing exercises can be a low-burden, highly effective tool to improve preparedness Help identify priorities for improvement

Can chocolate syrup protect you from Ebola?

A moving target PPE, clinical care guidelines for managing Ebola patients in US were stronger in guidelines were weaker

Do you have a clear communication strategy?

Don’t be reactive, be proactive Don’t be defensive

Do you have a clear communication strategy? “Few of the health departments in which we conducted exercises were proactive in their contacts with the media, and most waited until they were contacted by the media to begin communicating with the public.” Dausey et al.

Do you have a clear communication strategy? “One consequence of this passive approach was that public health officials often responded defensively to early and sometimes unexpected media requests and in turn, had trouble quickly formulating an initial message to the public that was clear, informative, and alleviated anxiety.” Dausey et al.

Do you have a clear communication strategy? “Health departments consistently expressed uncertainty about how to effectively communicate with vulnerable or underrepresented population groups in their jurisdictions, and few had well established relationships with community leaders or organizations that could serve as messengers or communications channels to these groups.” Dausey et al.

The hospital in December Net revenue and surgeries return to pre-Ebola levels ER visits are down 3.7%

Total impact $6 million spent on care, additional supplies, decontamination, transportation, support staffing, legal services, communications services, settlement with patient’s family

Recovery is a process Many stages Process duration, impact depends on preparedness Preparedness must include practice drills and a rehearsed communication strategy Potential for complete recovery – but at what cost?