Transcript PATIENT CARE STRATEGIES II

DEEP
Center
Disaster Behavioral Health
Awareness Training for
Health Care Professionals
Copyright © 2004: All Rights Reserved
Disaster Behavioral Health Awareness
Training for Health Care Professionals
James M. Shultz MS, PhD
Zelde Espinel MD, MA, MPH
Raquel E. Cohen MD, MPH
Jorge R. Insignares MD
Lisa Rosenfeld MPH
DEEP Center
University of Miami
School of Medicine
Brian W. Flynn EdD
Rear Admiral, USPHS (Ret)
Assistant Surgeon
General (Ret)
Jon A. Shaw MD, MS
Department of Psychiatry
University of Miami
School of Medicine
Robert J. Ursano MD
Director, Center for the Study of
Traumatic Stress
Uniformed Services University
of the Health Sciences
Joseph A. Barbera MD
Director
Institute for Crisis, Disaster, and
Risk Management
The George Washington University
Mauricio Lynn MD
Abdul Memon MD
S. Shai Gold
Jackson Memorial Medical Center
University of Miami
School of Medicine
DISASTER BEHAVIORAL HEALTH AWARENESS TRAINING FOR HEALTH CARE PROFESSIONALS
HOSPITAL AS A PATIENT CARE PROVIDER:
PATIENT CARE
STRATEGIES II
Patient Care
Strategies
Expand surge capacity
Conduct behavioral triage
Conduct behavioral
intervention
Manage contamination,
isolation, and quarantine
Maintain quality patient care
Support patient families
Meet special population
needs
Provide culturally-competent
care
Communicate with the public
Plan
Prepare & Mitigate
Respond
Recover
Pre-event
Event
Post-event
Train
Drill
Evaluate
Activate
Restore
Evaluate
Patient Care Strategies II
Key Concepts
 Manage contamination, isolation, and
quarantine
 Maintain ongoing quality patient care
Strategy:
Manage
Contamination,
Isolation, and
Quarantine
Patient Care
Strategies
Expand surge capacity
Conduct behavioral triage
Conduct behavioral
intervention
Manage
contamination,
isolation, quarantine
Maintain quality patient care
Support patient families
Meet special population
needs
Provide culturally-competent
care
Communicate with the public
Plan
Prepare & Mitigate
Respond
Recover
Pre-event
Event
Post-event
Train
Drill
Evaluate
Activate
Restore
Evaluate
Goal: Manage
Special Contingencies
Care effectively for patients
who are
potentially contaminated
or must undergo
isolation or quarantine.
Plan for Special Contingencies
 Potentially-exposed
patients
 Patients selected for:
 Decontamination
 Isolation
Manage Special Contingencies—
Potentially-exposed Patients
Potentially-exposed Patients
 Provide full registration for all victims.
 Provide written information after
decontamination, triage, and initial treatment,
including agent-specific information.
 Provide information as it becomes available:
 Patient care information
 Test results
 Credible event information
 Emphasize the positive actions being taken.
Source: Barbera & McIntyre,2003, Jane’s Mass Casualty Handbook: Hospital
Potentially-exposed Patients
 Monitor patients under observation
for delayed symptoms.
 Enroll discharged patients in a
surveillance system.
 Provide behavioral health
evaluation and referral if indicated.
 Provide written information on
normal reactions to stress and
community resources.
Source: Barbera & McIntyre,2003, Jane’s Mass Casualty Handbook: Hospital
Manage Special Contingencies—
Patients Needing Decontamination
Decontamination
Behavioral Goal:
 Decrease hyperarousal
 Decrease anxiety and fear
Strategies:
 Explain procedure
 Remove activities from public view
Permanent Decon Area
Jackson Memorial Medical Center, Miami, FL
Post-Decontamination Triage Area
Jackson Memorial Medical Center, Miami, FL
Manage Special Contingencies—
Patients Needing Isolation
“Virtual visit” to the hospital during the SARS outbreak,
Hong Kong, 2003
Public Health
Disease Containment
Quarantine:
Compulsory physical separation, including
restriction of movement, of populations or
groups of healthy people who have been
potentially exposed to a contagious
disease, or efforts to segregate these
persons within specified geographic areas.
Source: Barbera et al., 2001
Public Health
Disease Containment
Isolation:
Separation and confinement of
individuals known or suspected (via
signs, symptoms, or laboratory criteria)
to be infected with a contagious disease,
to prevent them from transmitting
disease to others.
Source: Barbera, et al., 2001; Gostin 2000
Public Health
Disease Containment
Quarantine
 Possible infection with contagious
disease
Isolation
 Confirmed infection or contagious
disease
Behavioral Health Implications
of Isolation/Quarantine
Behavioral Goals
 Reduction of psychological distress
 Compliance with containment measures
Stressors
 Separation from loved ones
 Fear of impending illness
 Fear of death
 Stigma
 Social isolation
Behavioral Health Implications
of Isolation/Quarantine
Strategies
 Provide basic needs
 Provide information as it becomes
available
 Maintain communication with loved ones
 Provide access to media
 Provide psychoeducation
 Provide compassionate/empathic care
 Provide behavioral health support
SARS,
2003
SARS, 2003
In Hong Kong and Singapore:
 Mandatory quarantines implemented in large
residential areas
 50% of the population fled before quarantine
could be enforced
In Canada:
 Voluntary “shielding” strategy implemented
 Extensive public education
 Home visits by doctors
 Worked well
Source: Pilch, 2004
Shelter in Place (Shielding)
 Citizens instructed to remain at home
for several days or weeks
 Self-imposed measure to contain or
minimize an epidemic
 Education, information, food, and
access to home health care provided
 Alternative to quarantine
Source: Pilch, 2004
Shelter in Place (Shielding)
 Maintains normal routines
 Keeps families together
 Decreases traffic flow
 Minimizes patient surge
 Targets delivery of health
services to persons
developing symptoms
 Minimizes restrictions on
civil liberties
Source: Pilch, 2004
Behavioral Health Perspective:
Manage Contamination,
Isolation, and Quarantine
When dealing with special
contingencies due to contamination
or infection…
Plan for the behavioral needs of
patients who are exposed or
require decontamination or
isolation.
Strategy:
Maintain Ongoing
Inpatient Care
Patient Care
Strategies
Expand surge capacity
Conduct behavioral triage
Conduct behavioral
intervention
Manage contamination,
isolation, and quarantine
Maintain quality
patient care
Support patient families
Meet special population
needs
Provide culturally-competent
care
Communicate with the public
Plan
Prepare & Mitigate
Respond
Recover
Pre-event
Event
Post-event
Train
Drill
Evaluate
Activate
Restore
Evaluate
Goal: Maintain Ongoing
Inpatient Care
Maintain quality care for
current patients.
Manage degradation of care
to accommodate the
patient surge.
Maintaining Ongoing
Inpatient Care
“In a massive disaster, many
chronically ill patients could lose
access to their physicians or settings
where they usually receive care or
obtain medications.”
“In a disaster event, care for
hospitalized patients may deteriorate.”
Source: JCAHO, 2003
Plan for Maintaining Care for
Existing Patients
 Prepare to optimize
care for inpatients
 Prepare for early
discharge
 Prepare for patient
transport
 Prepare for “graceful
degradation” of care
Plan for Graceful Degradation
 Treat and board patients in hallways.
 Ration care and personnel contact as
needed.
 Provide protection from legal actions
due to unavoidable delivery of substandard care during declared
emergencies.
Source: JCAHO, 2003
Track Patients
Track patients within the
hospital and across the
community to achieve the
highest-possible quality care
and reunite family members
Behavioral Health Perspective:
Maintain Quality Patient Care
While accommodating a surge of
incoming patients during a
terrorist event…
Hospitals must maintain ongoing
quality care for current patients
and carefully manage
degradation of care.