Recent events surrounding the diagnosis of Ebola on U.S. soil have proven that we can't always predict when and where an infectious disease will present.
Texas Health Presbyterian Hospital Dallas wasn't really prepared for a person who would test positive for Ebola to walk into their emergency room, nor were they prepared to support their staff during his treatment after admission. It seems there were several weaknesses in planning and preparation that resulted in missed opportunities to minimize the risk of their staff becoming infected with the disease.
Perhaps leadership didn't think an Ebola positive patient would walk through the door. Perhaps they thought that if one did, they had the necessary supplies, alternate workflows and staff knowledge in place to have a successful outcome.
The reality is that they did not have a positive outcome and will suffer in multiple areas as they attempt to return to normal operations. Texas Health leaders, and those in their system, must accept some responsibility for the outcomes, including damage to their reputation, a significant drop in their daily census and the potential for significant liability findings and loss.
The events of 9/11 highlighted the need for improved communitywide emergency preparedness. That resulted in funding allocated for the Hospital Preparedness Program (HPP) and Public Health Emergency Preparedness (PHEP) programs. Together, these two programs help build capacity and fill gaps.
The funds supplement local provider allocations to support communitywide planning and preparedness for more a coordinated local-response effort. This includes securing necessary supplies and equipment, training staff and volunteers, developing a plan and doing exercises to test readiness.
However, in recent years this funding has been steadily decreasing:
- $515 million in 2003 for HPP to $255 million in 2014
- $940 million in 2003 for PHEP to $653 million in 2014
This funding has been instrumental in bringing community providers together with public health for more integrated planning, but some work still remains.
- Supplies expire or are used in exercises (drills) and must be replenished
- Equipment must be maintained and periodically replaced
- Plans must be updated and expanded as new risks or strategies are identified
- Staff training needs are continual to keep pace with risks, strategies, plans and turnover
- Planning and exercises to test readiness must be repeated
In the case of training, it isn't something you can complete and then move on. Effective outcomes result from continually being prepared. Training needs are continuous not only because diseases and risks evolve and response strategies shift, but also because older workers retire and are replaced by younger workers who need to build skills and experience.
There is a possibility that the reduction in funding did contribute to this hospital not being prepared, or perhaps it did not. Irrespective of the root causes in this case, planning and testing preparedness for disasters and disease must remain a priority. It is not a matter of if they will occur, but when.
Proactively minimizing risks and reducing the likelihood of adverse outcomes requires continual investment of resources when it comes to emergency preparedness — by both providers and public health. While there is a cost to preventing the spread of disease, it is far less than the cost of the alternative.
Consider what Texas Health's total cost will be just for:
- treatment for the patient and two staff members
- loss of confidence among the community
- business disruptions
- attention and fines from state and federal licensing, accreditation and regulatory bodies
- potential malpractice, workers' compensation and other liability claims.
Just as Hurricane Katrina was, Ebola is a wakeup call for healthcare providers and communities. We can either pay now for prevention or pay more after the next natural or man-made threat occurs.
