No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015–2016

Abstract

Mystery patient drills using simulated patients have been used in hospitals to assess emergency preparedness for infectious diseases, but these drills have seldom been reported in primary care settings. We conducted three rounds of mystery patient drills designed to simulate either influenza-like illness (ILI) or measles at 41 community health centers in New York City from April 2015 through December 2016. Among 50 drills conducted, 49 successfully screened the patient–actor (defined as provision of a mask or referral to the medical team given concern of infection requiring potential isolation), with 35 (70%) drills completing screening without any challenges. In 47 drills, the patient was subsequently isolated (defined as placement in a closed room to limit transmission), with 29 (58%) drills completing isolation without any challenges. Patient–actors simulating ILI were more likely to be masked than those simulating measles (93% vs. 59%, p = 0.007). Median time to screening was 2 min (interquartile range [IQR] 2–6 min) and subsequently to isolation was 1 min (IQR 0–2 min). Approximately 95% of participants reported the drill was realistic and prepared them to deal with the hazards addressed. Qualitative analysis revealed recurring themes for strengths (e.g., established protocols, effective communication) and areas for improvement (e.g., hand hygiene, explaining isolation rationale). We conclude that mystery patient drills are an effective and feasible longitudinal collaboration between health departments and primary care clinics to assess and inform emergency preparedness for infectious diseases.

Disaster Preparedness and Professional Competence Among Healthcare Providers: Pilot Study Results

“…It is also unclear whether individual procedures can reliably predict, in real time, the effectiveness of hospital functions [15][16][17]. Although many studies [18][19][20][21][22][23][24][25][26][27] have assessed the correlation between the level of hospital preparedness and disaster response, only a few functional elements have actually been assessed.…”

Assessment of New York City Urgent Care Centers’ Emergency Preparedness and Infection Prevention and Control Practices, 2016–2017

“…7 Mystery patient drills, which have been utilized in NYC emergency departments and primary care centers, are an example of tool that could be adapted to test the implementation of IPC or EP practices in other settings that see patients with acute illnesses such as UCCs. [22][23][24] These drills can assess healthcare facilities' readiness to respond to patients with communicable diseases of public health concern; scenarios could be modified to fit the urgent care setting and test a variety of capabilities. Another opportunity would be to involve UCC stakeholders in jurisdictional planning and joint healthcare coalition exercises for disasters, including coastal storms and mass casualty events, where UCCs could serve as alternate care sites to decompress emergency departments.…”

Establishment of a no-notice drill mode evaluation system for public health emergencies

“…In the available literature, research on no-notice drills for public health emergencies at home and abroad is relatively limited: most studies focus on emergency disposal and emergency treatment of mass casualties [ 1 – 3 ], mass evacuation [ 4 ] and no-notice drill of mass vaccination [ 5 ]. In addition, there are studies on no-notice drills for public health emergencies, such as the Ebola no-notice drill held in Taiwan in 2014 [ 6 ] and a no-notice drill held in New York City for respiratory infectious diseases such as measles and influenza in 2015 [ 7 ]. However, these exercises mainly evaluated the hospital’s emergency preparedness for public health emergencies and failed to assess the ability of epidemiological investigators in an epidemic situation4.…”

“…The evaluation system of the no-notice drill has not been deeply studied. The construction of these drill evaluation systems mainly relies on some existing drill guidelines, such as the “Hospital Surge Evaluation Tool” used to evaluate the emergency response capacity of mass casualties [ 3 ], the Homeland Security Exercise and Evaluation Program (HSEEP) [ 5 , 7 ], the hospital evaluation standards and hospital infection control guidelines issued by China [ 6 ], and some of them adopt the simple Delphi method [ 4 ]. Compared with the Delphi-AHP, these studies are arbitrary and lack scientificity in the selection of indicators, especially in the determination of weight, which is not conducive to the evaluation of emergency capacity.…”