'Mystery patient' drills put NYC emergency rooms to the test

'Mystery patient' drills tested if NYC emergency rooms could identify patients with communicable disease.

Emergency departments in New York City generally performed up to task in a series of “mystery patient” drills that were designed to test if ER staff could identify and isolate patients with symptoms of communicable diseases, a new study shows.

Researchers from the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention conducted 95 drills from December 2015 to May 2016, according to the research published in the CDC’s Morbidity and Mortality Weekly Report.

Patients participating in the study visited the ER and reported signs and symptoms consistent with either measles or Middle East Respiratory Syndrome (MERS). The patients were masked and isolated in 78% of cases, though 39% of the 49 hospitals in the study failed at least one of the drills by keeping the patients waiting for longer than 30 minutes without triage.

Two hospital employees, acting as “trusted agents,” were informed of the drills, leaving the clinical ER staff in the dark. At least 80% of patients were asked about recent fevers, 50% were asked about skin lesions and more than two-thirds were asked about respiratory symptoms.

The vast majority (88%) of patients were given a mask, with 1.5 minutes as the median time between the patient’s entry into the ER and when they were given the masks. The study found a median time of 8.5 minutes from entry into the ER into isolation, which is comparable with previous drills using Ebola symptoms.

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Patients with a travel history were far more likely to be masked and isolated, though there was some confusion among the ER staff as to which locations were risky. The researchers recommend clinicians routinely ask patients about travel.

“The finding that masking and isolation occurred significantly more frequently in situations where a travel history had been elicited suggests that routinely inquiring about recent travel could prevent exposures to infectious patients at critical entry points to the healthcare system,” researchers said.

The researchers also examined the ED teams’ infection control measures and found that just 36% of staff members performed personal hand hygiene. Only 16% told patients to do so.