Amesh A. Adalja, MD, FACP, FACEP, July 10, 2015
The misdiagnosis and subsequent nosocomial transmission of Ebola virus disease (EVD) in a Texas hospital last year demonstrated that some, if not many, US hospitals were ill prepared for a highly lethal and moderately contagious infectious disease like EVD. Therefore, a handful of uniquely equipped biocontainment units, staffed by specially trained healthcare personnel, were relied on for the provision of care to patients. However, because of the ongoing outbreak in West Africa, there was a real possibility that other hospitals might find themselves caring for an Ebola patient at their facility for some amount of time. Thus, it became incumbent on all hospitals to prepare for this possibility.
A remarkable approach taken by hospitals in the Chicago region was recently described in Clinical Infectious Diseases.
Because Chicago is one of the nation’s top population centers, its airport is a major international hub, and it has a large resident population of West Africans, the medical centers in the area judged themselves to be at high risk and, therefore, established the Chicago Ebola Response Network (CERN).
CERN was formed by 4 Chicago academic medical centers in conjunction with the Chicago Department of Health with the aim of ensuring that any suspected EDV patient would be cared for at a designated hospital as rapidly as possible. Operationally, once a person was designated as being under investigation for Ebola, CERN’s chief medical officer (CMO) would then contact the CMO of the CERN hospital that was next up in the rotation so the patient could be transferred to that facility. The network worked directly with officials at O’Hare Airport. To date, CERN has evaluated and ruled out 5 persons under investigation for Ebola.
As the authors of the paper note, CERN leveraged the resources of 4 extremely adept academic medical centers to optimize care. Specifically, as discussed in the paper, the ability to pool expertise and resources while distributing risk were major advantages of this approach. As caring for just 1 potential Ebola patient can stress resources at a major medical center, having a coalition of hospitals is a crucial means to mitigate that risk.
Healthcare emergency response coalitions, which have grown, evolved, and matured over the past decade, have increasingly been noted to be a major factor in regional resilience for all types of hazards, from emerging infectious diseases to mass casualty traumatic accidents. Some of the key features of the CERN coalition that merit emphasis are the involvement of the highest level of hospital leadership, as represented by the CMO, and the crucial partnership employed with the airport—not traditionally considered a healthcare asset. CERN represents a good model for regional preparedness and an effective approach to emergency response.
Lateef O, Hota B, Landon E, et al. CERN: a city-wide cross-hospital collaborative for infectious diseases preparedness. Clin Infect Dis 2015. http://cid.oxfordjournals.org/content/early/2015/06/28/cid.civ510.full.pdf+html. Accessed July 7, 2015.