Revisit your process for infectious diseases

Recently, a patient at Northwest Medical Center in Tucson, AZ, was diagnosed with measles and ordered into isolation by her physician, but remained unisolated in the ED for more than 12 hours. One way to avoid such mistakes, say the experts, is to hone all of your infection control processes.

"For example, everyone who comes in with a cough, a sneeze, or flu-like symptoms, they should get a mask," advises James G. Adams, MD, chair of emergency medicine at Northwestern Memorial Hospital in Chicago. "It may be infectious or it may be allergies, but this way the intake nurse will not have to make a complicated judgment, but automated responses to improve safety."

Matt Keadey, MD, the medical director of the ED at Emory University Hospital in Atlanta, agrees. "You can approach it in a manner similar to what was done with SARS [severe acute respiratory syndrome]," he suggests. "Develop a set of criteria for the initial presentation of people you think might need to be isolated — like fever and rash, a cough, and travel to certain parts of world."

The most important thing is to determine the appropriate level of isolation based on your concerns, he says. Every ED clinician also should understand what each level of isolation requires in terms of protective equipment and process. Does the patient need a mask? What about visitors? Who is required to wear gowns into the room?

How do you communicate those concerns to your staff? The tracking board is often the most useful place for notifying staff, as well as signage at the entrance to the room. "We have EMR [electronic medical record] here, so I do a lot our requests electronically, but however you communicate, there has to be a good process set up, and it needs to be followed all the time without ambiguity," says Keadey.

The doctor and the nurse are responsible for seeing that the order is followed, Keadey says. "It's a team, like in any ED," he notes.