Addressing the Global Zika Epidemic Locally

Abstract

Escalating evidence for the fetal impact of Zika virus infection required a change in care by all prenatal providers. This article describes an effective model of rapid implementation of universal prenatal screening at one hospital and its network of community health centers for a large and diverse immigrant population exploring the challenges, experiences, and lessons learned. Implementation of national recommendations required a workflow change, challenging a system with a heterogeneity of settings and providers. Using a physician clinical champion and advanced practice nurses in the roles of logistical coordinator and liaison to the network, Zika screening was embedded into prenatal intake visits at both the hospital and community health centers. Challenges addressed include varied medical record systems, acceptance by patients, providers, and community health center leadership, as well as culturally appropriate outreach to diverse ethnic and linguistic communities. In 6 months, the prenatal screening rates increased from 20% to 88%, which resulted in the identification of more than 300 pregnant patients at risk of exposure to Zika virus. This model offers key lessons for emergency preparedness in heterogeneous, safety net hospital settings.

Clinician Champions’ Influence on Social Needs Screening Volumes in Pediatric Practices

“…10 Another study showed that the use of a clinician champion was key to the success of universal screening for Zika virus during prenatal visits. 11 With respect to social needs screening, implementation was more likely to be successful if an internal advocate was present 12 to facilitate the process of incorporating screening into clinical routines; however, in this study, the screening advocate was usually not a clinician. To our knowledge, no other studies examine the impact of clinician champions on social needs screening.…”

“…Other studies have shown that screening can be highly successful during a pandemic with the active participation of clinician champions. 11 The higher screening rates during the pandemic may be attributed to clinicians recognizing increased social needs among the patient population due to the soaring rates of unemployment, food insecurity, and housing instability reported in the media and during individual encounters. Furthermore, at the peak of the pandemic, clinic visit volumes dropped significantly, leaving clinicians with more time to address the social needs of their patients and families.…”

“…10 Another study showed that the use of a clinician champion was key to the success of universal screening for Zika virus during prenatal visits. 11…”