Covering all the bases


Covering all the bases

What’s it like to be a risk manager at a hospital where Ebola patients are being treated? HRMR spoke to Dave Poppert, risk manager at Nebraska Medicine, about the center’s specialized approach.

Nebraska Medicine has hit the headlines many times over the past few months—first, for successfully treating Dr Rick Sacra for Ebola, then for its success in treating its second Ebola patient, Ashoka Mukpo, and most recently due to the death of Dr Martin Salia, who was critically ill, with no kidney function and unresponsive by the time he arrived at the center, and did not recover.

While risk managers all over the US are considering how to prepare for the possible arrival of a suspected Ebola patient, Dave Poppert, Nebraska Medicine’s transferred risk and claims management manager is one of a tiny handful of US healthcare risk managers with first-hand experience of dealing with the presence and treatment of Ebola patients in his facility.

Nebraska Medicine, and Nebraska Medical Center location in particular, were chosen for the treatment of Ebola patients largely because of its distinct capabilities in dealing with these types of pathogens. It has a special biocontainment unit that was brought on-line in 2005. This is the largest unit of its kind in the US.

Special features

The unit has a number of unique features that allow for the treatment of patients with highly infectious diseases. It has a separate air-handling system with special filtration, a dunk tank for laboratory specimens and a pass-through autoclave. In addition the unit is staffed by a highly trained team of medical professionals who participate in frequent drills in order to maintain proficiency.

Poppert says that when planning for the possible arrival of Ebola patients, it’s important to understand that preparation begins well in advance of the event and is very much a team effort.

“Having the full support of our governing board and senior leadership team as well as having highly trained and capable clinicians goes a long way toward mitigating any of the potential risk issues that might emerge,” he says.

The organization’s history of embracing an ‘all-hazards’ approach to emergency planning and our focus on enterprise risk management (ERM) undoubtedly put it at a significant advantage in responding to this issue, he adds.

“Knowing in advance the capabilities of our clinical team and the unique features of our biocontainment unit was also very comforting from a risk management standpoint. It allowed me as a risk management professional to focus on supporting the process of identifying and evaluating other potential risks and helping to mitigate them.”

The importance of planning

When dealing with Ebola patients, Poppert says it is important to have the basics covered as far in advance as possible.

“From a clinical perspective, having the appropriate protocols and personal protective gear in place is pretty obvious, but what about issues that might arise in other risk domains?

“For instance, are you confident about how your various transferred risk programs would respond? Does your workers’ compensation coverage have an epidemic disease endorsement that would treat any exposures as a single claim, or would it treat any exposures as multiple discrete claims, each with their own deductible?

“Have you considered the logistics of dealing with a significant and extended media presence descending on your campus? How do you reassure your existing patients that they are safe from exposure in their environment? There are obviously numerous considerations, so the sooner you get the basics addressed, the better position you will be in to deal with other issues that might arise.”

Collaborating with local and state health departments to assure all are on the same page is another key consideration, he adds.

Nebraska Medicine’s Biocontainment Unit has been in place for a number of years so its team has had a lot of practice by way of drills. This experience has allowed them to refine their protocols over time in order to minimize the chance the virus could be transmitted.

“A significant feature of our protocol involves having a dedicated observer whose sole job is to monitor the process of putting on and removing the protective gear,” says Poppert. “Our clinical staff really rely on each other to ensure proper infection control protocols are followed at all times.

“Additionally, the level of collaboration our clinical team has had with other clinicians across the country has played a significant role in the successes we’ve experienced.”

An all-hazards approach

Asked what tips and advice he would give to risk managers in other US hospitals who are seeking to prepare themselves for the possibility that a patient may come to their hospital with suspected Ebola, Poppert says it is important to prepare and train now and to do so utilizing an ERM framework and all-hazards approach.

“If you prepare your organization in this context, you’ll be in a better position to respond to the next emerging issue,” he says. “One of the most significant challenges risk managers will face is in trying to identify, quantify and manage the peripheral risks of dealing with a suspected Ebola patient. As risk managers, we are all adept at managing discrete risks, but this scenario brings with it a host of ‘non-traditional’ risks to manage.

“How do you sustain your organization’s normal capacity for treating patients if a suspected Ebola patient presents to one of your facilities? How do you assess and mitigate the operational disruptions? How do you quantify the potential loss of revenue from elective patients who might seek services elsewhere? A lot of these issues can be mitigated with effective communication, but your organization’s message both internally and externally needs to be clear and consistent and transparent.”

Poppert says the main lesson he has learned during the time that Nebraska Medicine has been treating Ebola patients is to expect the unexpected.

“You can only do so much by way of pre-planning. You can’t possibly work through every contingency or script answers for every question in advance. As an organization you have to have the right framework in place to address emerging issues.

“From a clinical perspective, lessons learned have been quickly identified and adjustments are made on a continuous basis. As an example, for our second patient with Ebola virus disease, we moved our point of care testing lab in to the Biocontainment Unit. Other minor tweaks are made daily to continue to enhance overall safety.”

In order to put US healthcare in the strongest possible position for dealing with Ebola, Poppert believes that hospitals really need to hard wire an all-hazards approach into their emergency planning and business continuity preparations.

“That way they can respond proactively in real time instead of ramping up whenever a new crisis (in this case Ebola) arises. The challenge is mustering support for this type of approach at a time when there are so many competing operational demands and maintaining the organizational stamina once the initial crisis has passed.”

Dave Poppert, Ebola, Nebraska Medicine, US, Crisis management