One Healthcare System’s Response to the Chaos Swedish Health Services Swedish Medical Centers: Ballard, Cherry Hill, Edmonds, First Hill, & Issaquah Ambulatory Care Centers: Mill Creek & Redmond Swedish Medical Group: Primary Care Clinics

Background: Why Ebola Spread Ebola is a relatively unstudied disease with more questions than answers about its mechanisms of transmission and clinically based evidence for treatment. In addition to these factors, West African countries with poor healthcare infrastructure and social/economic influences foster a suitable environment for widespread transmission of Ebola Virus Disease (EVD).

Problem Statement Globalization and the ease of travel by aircraft have made it increasingly difficult to contain exotic highly infectious and contagious diseases such as EVD. Communities and Hospitals in particular are faced with building robust identification, evaluation and treatment strategies.

The Long Road to Readiness Prior to September of 2014, the High Level Containment (HLC) Plan had not been validated with practical hands on testing through a shared leadership model for efficacy. Once Ebola took center stage, a multidisciplinary Hospital Incident Management Team convened to design a multilayered approach to Identifying, Containing, Diagnosing and Treating highly contagious diseases. Background Statement

Issue Identification Escalate (Treatment) How do we mobilize a highly trained and specialized team to provide treatment/transportation for a PUI for EVD? Identify (Recognition) How does a Healthcare System with five hospitals, two Ambulatory Care Centers and over 135 Primary Care Clinics identify potential travel/exposure risks when registering the thousands of patients treated each day? Isolate (Evaluation) What education and training is needed for frontline staff to safely evaluate and contain a Person Under Investigation (PUI) for Ebola Virus Disease (EVD)? (EVD)?

Issues Environment of Care Design/Capability How do we equally and fully integrate patient safety with staff and environmental safety? What controls and safeguards are needed to prevent exposures and how do we keep a proactive approach when identifying issues as they arise?

Action Plan Identify In order to ensure all patients are screened, Swedish built in a layered awareness program from every point of entry including a series of “hard stop” questions in Epic to be asked at all points of initial contact between staff and patients.

Action Plan Identify

Action Plan

Isolate At each hospital’s Emergency Department, at our Issaquah Campus’ modular High Containment Isolation Unit, the ACC’s and at every clinic; a room was pre-identified and outfitted with the necessary equipment to care for a PUI for EVD.

Action Plan Isolate

Action Plan Escalate After isolating a PUI for EVD, all front line staff are educated and trained on how to escalate to a team of experts for implementation of the designated treatment plan.

Escalate Action Plan

Containment The Issaquah Hospital was designated as the Swedish System’s evaluation and treatment hospital. The hospital’s central location and state of the art facility with Airborne Infection Isolation Rooms (AIIR) make it well suited to care for EVD patients.

Action Plan Containment

Action Plan Containment

Action Plan Implementation 1.Developed a train the trainer model to teach PPE at all locations 2.Recruited a HLC care team for designated evaluation center 3.Real world simulation training with multiagency collaboration 4.Shared leadership review of processes 5.Environmental upgrades and technological enhancers 6.Screening Triage Tool implementation 7.Epic screens to document travel 8.An online HealthStream module 9.Training for proper donning and doffing of PPE (Buddy teams) 10.Practical Drills to test effectiveness 11.Hazardous waste containment and disposal 12.High level containment cleaning protocol 13.Built Modular Lab and specimen collection protocol 14.Rapid response PPE kits for each Emergency Department 15.Scripting for patient education on process for rule out cases 16.Triage for appropriately triaging and transferring suspected or confirmed patients to the appropriate care environment Improvements/Implementations

Action Plan Implementation Training as a Team

Action Plan Implementation Community Collaboration

Continual Readiness As part of our philosophy to continually improve, Swedish has conducted numerous PPE training sessions for all ED staff and uses full scale training exercises to evaluate the readiness of the care plan for our highly trained and dedicated Ebola assessment team. Our technologically advanced simulation center has provided realistic training for staff to be exposed to caring for a highly contagious patient population. An evaluation by DOH was conducted on March 18 th where Swedish was granted the designation as an Ebola Assessment Center. The exhaustive planning and preparation will also be tested with a culminating 12 hour full functional drill on May 7 th as a display of readiness.

Continual Readiness

Ready! Even for the Zombie Apocalypse