Feds consider tiered hospital system for Ebola patients

Pedestrians walk outside Texas Health Presbyterian Hospital in Dallas, Tuesday, Sept. 30, 2014.  (AP Photo/LM Otero)
Pedestrians walk outside Texas Health Presbyterian Hospital in Dallas, Tuesday, Sept. 30, 2014. (AP Photo/LM Otero) AP

Hoping to avoid mistakes made in the treatment of Ebola patients in Texas, federal health officials are considering a plan to designate top-tier hospitals as referral centers for the treatment of potential Ebola cases.

That would limit the number of health care workers who must become expert at taking care of patients with the highly contagious and often deadly disease. Other hospitals still would need to be prepared to identify potential Ebola patients for transfer to the appropriate hospitals for treatment.

The push comes in the wake of mistakes at the Dallas hospital that treated Ebola patient Thomas Eric Duncan – and where two nurses subsequently became infected with the virus – and as several nurses’ unions across the country worry about the preparedness level of local medical centers.

Already, states have begun designating specific hospitals as the best places to send Ebola patients. Two in Texas, for example, will have bio-containment facilities to rival those specially equipped to deal with Ebola patients elsewhere, such as at Emory University in Atlanta and the National Institutes of Health in Bethesda, Md.

“From what we have learned (in Texas), this is the way to go,” said Dr. Jeffrey Engel, executive director of the Council of State and Territorial Epidemiologists, based in Atlanta. “Regionalization is going to be necessary from a safety and pure logistics and financial concern.”

On Wednesday, North Carolina Secretary of Health and Human Services Aldona Wos said she is aware of the plan for a regional approach for care of Ebola patients and is surveying hospitals to see which ones “might wish to serve” as referral centers in North Carolina.

And on Tuesday, Texas Gov. Rick Perry announced two designated bio-containment hospitals in his state that would provide specially trained workers and equipment to treat Ebola and other infectious diseases.

In the Dallas suburb of Richardson, a bio-containment unit was created in a matter of days at the urging of federal and state officials. Another unit was designated in Galveston.

Officials in some other states, including Pennsylvania and New York, also have designated hospitals as regional medical providers should an Ebola case arise.

In Atlanta, Engel said he has had conversations with national experts about what he described as a three-tiered hospital system to handle potential Ebola cases in the United States.

Top-tier hospitals, which would accept known Ebola patients for treatment, would be designated after a “quasi-certification process,” which would involve official site visits, Engel said. “That is the best we can do ahead of testing it with a real Ebola patient,” Engel said.

Stephanie Goodman, a spokeswoman for the Texas Health and Human Services Commission, said in an email that the two centers announced Tuesday would fit the description of hospitals in a top-tier system.

The center in Richardson was created after officials from the U.S. Centers for Disease Control and Prevention and the state said they wanted to use the 10-bed unit for any new Ebola patients in the Dallas-Fort Worth area, said Sam Bagchi, Methodist Health System’s chief quality officer. “We moved 24/7 to get this unit into operation.”

For the top tier, Engel said, “We need hospitals with robust bottom lines. They’re not going to get reimbursed for any of this. They’re not going to able to bill the patient’s insurance for the ‘buddy system’ and all the personal protective equipment they’re going to need.”

Second-tier hospitals would be located around the five major airports where most West Africans arrive in this country – New York City, Newark, N.J., Atlanta, Chicago and Washington.

Those second-tier hospitals would be “ready to take a person directly from the airport and triage them safely” before transferring them to a first-tier hospital, Engel said. These second-tier hospitals would have trained emergency room staff, isolation rooms and testing facilities “so these people could be tested and isolated quickly.”

The third tier would be “every other hospital in the United States,” and they would need to have “basic triage readiness” to identify a potential Ebola patient and isolate them until they could be transferred. “These folks would be screeners, testers and transporters. Really a 1-2-3 process,” Engel said.

If a patient walks in and says, “I don’t feel well. I have a fever,” Engel said, these third-tier hospitals should be ready to ask the patient about their travel history. “That should be the first question.”

Garloch, of the Charlotte Observer, reported from Charlotte, N.C. Hanna, of the Fort Worth Star-Telegram, reported from Fort Worth, Texas. Wise reported from Washington. Tony Pugh of the Washington Bureau contributed to this report.

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