Access controls’ addressed
As hospitals put procedures in place for the possible reemergence of severe acute respiratory syndrome (SARS) during the approaching respiratory disease season, the Atlanta-based Centers for Disease Control and Prevention (CDC) has issued a draft report designed to assist in those efforts. A number of recommendations regarding the role access departments will play in SARS preparedness are in the report, including steps for restricting access to health care facilities and for implementing effective surveillance and screening. An informal survey by Hospital Access Management showed access professionals are gearing up for a potential SARS outbreak, with efforts typically centered in the emergency department (ED).
Patients at the University Hospital of Arkansas in Little Rock, for example, are triaged by ED clinicians before her employees ever see them, says Holly Hiryak, RN, CHAM, director of hospital admissions. "If patients are suspect for SARS, [ED clinicians] relay the registration information to us."
His staff consult a book of signs and symptoms when triaging suspected SARS patients, and ask a few key questions if those signs and symptoms are present, explains ED director Glenn Raup. "The signs/symptoms are those that appear flulike — cough, fever, chills, etc. — over the past two to 10 days," Raup says. "The questions have to do with travel outside the country — and where — or travel through an airport within the past month. This is done at triage by the technician while collecting the initial data."
If the findings are positive, he adds, the patient stays at the triage area and the technician notifies the triage nurse or the charge nurse. "From there, the nurse will confirm the answers to the questions, review the vital signs, and if the level of suspicion is still high, notify the ED attending physician to come to triage and see the patient."
If the ED attending physician also suspects SARS, Raup says, "the patient is given a mask and taken directly to one of our three negative-pressure rooms. The rest of the staff is notified, signs for general isolation precautions are placed on the door, and the department of health is notified."
Plan offers framework
The draft plan, which is available at www.cdc.gov, suggests the following activities under the heading "Hospital Access Controls." According to the plan, these steps should be taken when SARS is present in the community surrounding a health care facility:
- Establish criteria and protocols for limiting hospital admissions, transfers, and discharges, in accordance with local/state recommendations and regulations, in the event that nosocomial SARS-CoV transmission occurs in the health care facility.
- Establish criteria and protocols for closing the facility to new admissions and transfers, if this becomes necessary.
- Establish criteria and protocols for limiting hospital visitors.
- Determine when and how to involve security services to enforce access limitations. Consider meeting with local law enforcement officials in advance to determine what assistance they might be able to provide.