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Case Management Storyboard 3: Hospital Cases

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Case Management storyboard describing messages related to Inpatient Care

The Province is currently in the midst of a SARS outbreak ‘though no cases have yet been reported at Anytown Hospital. Neville Nuclear has just arrived at Anytown hospital with a fever and respiratory symptoms. As part of the admission process, hospital staff conduct a SARS risk factor assessment interview. As a result, Neville is admitted as a suspect SARS case.

Annie, the hospital’s Infection Control Practitioner (ICP), sends an [Investigation Request] to Nurse Nightingale, at the local health unit. Nightingale records Neville as a suspect SARS case and makes arrangements to interview him at the hospital. Nightingale queries her own records and those in neighbouring jurisdictions [Case Candidate Query/Response] to determine where other SARS cases have been reported. She will use this information when interviewing Neville, to determine if he has visited any of these “hot zones”. During his interview Neville confirms having spent time at a facility that has already been identified as an exposure site for the current SARS outbreak. Neville identifies only his wife as a close contact.

Now that she has identified Neville’s contacts Nurse Nightingale sends a notification to the provincial Ministry of Health indicating that Anytown has its first suspect SARS case and provides an estimate of the number of case contacts that are currently being followed [Case Create Notification]. The Ministry will later send an Outbreak Update Notification to all the other Health Units that will include Neville’s case in the overall case counts. This notification will include instructions about reporting any suspect cases, assessment criteria, emergency reporting instructions (e.g. fax, telecom) and care requirements for patients e.g. quarantine period, preferred treatment location(s).

Nurse Nightingale contacts Neville’s wife and places her on a 10 day quarantine. Nightingale also sends the hospital a list of care recommendations for Neville [Care Plan Request].

Nightingale performs a query of the EHR to determine if there’s a trend in the number of new cases involving a fever and respiratory symptoms [Get Care Record Candidates Query/Response]. No additional cases have been reported in the other hospitals in the region.

Two days into her 10 day quarantine, Neville’s wife arrives at the emergency department with a fever and respiratory symptoms. During her intake interview the staff learn that Mrs. Nuclear is related to someone who is being monitored by public health, as a case contact - in other words, her husband Neville. The ER staff therefore report these admission findings to Annie, the Infection Control Practitioner, who then sends an [Investigation Request] to public health.

As requested by Public Health Annie provides Nurse Nightingale with daily updates on both Neville and his wife. She sends reports to public health describing any changes to each client’s condition (e.g., rising temperature, changes in respiratory status) [Notification message - tbd].

The Ministry requests that Neville and his wife be transferred to Greenville hospital, which has been designated as the local SARS treatment centre. Nightingale forwards this request to the hospital [Care Plan Request]. The Province has strict transfer control protocols for SARS cases that require the hospital to make arrangements and get approval from the Provincial Transfer Authorization Centre (PTAC). Once this is done Annie (the ICP) sends a notification of the upcoming transfer to Nurse Nightingale at the public health unit [Pending Discharge Notification]. Since the newly designated SARS hospital lies within her jurisdiction, Nightingale will continue to monitor these cases.

Neville is subsequently discharged from Anytown hospital and Nightingale receives an electronic message from the hospital’s ADT system, confirming the discharge [Discharge Summary Notification].

When Neville is admitted to Greenville hospital the transfer form that accompanies Neville indicates that Public Health is monitoring his case and supplies Public Health contact information, care plan recommendations and reporting requirements. As instructed on the transfer, the Greenville Hospital’s Infection Control Practitioner (ICP)) contacts Nightingale upon Neville’s arrival and thereafter provides Public Health with updates on Neville’s condition and changes to his care plan.

Neville remains at Greenville hospital for two days before his condition worsens. He must now be transferred to Blueville hospital, which lies in another jurisdiction. The ICP at Greenville informs Nurse Nightingale of Neville’s worsening condition and the impending transfer [Pending Discharge Notification]. Nightingale arranges for transfer of the case to the Blueville public health department who will now assume responsibility for monitoring his progress on behalf of Public Health [Case Transfer Request]. The transfer request includes information about his pending hospital transfer.

Meanwhile, back at Greenville hospital Mrs Nuclear, (Neville’s wife) has improved and is ready for discharge. Lucy (Greenvillle’s ICP) notifies Nurse Nightingale of the estimated discharge date and time [Pending Discharge Notification]. Nightingale in turn requests that the hospital provide Mrs. Nuclear with surgical masks, a thermometer, care recommendations and public health contact information [Care Plan Request].

Mrs. Nuclear is discharged shortly thereafter and Nightingale receives a summary of her stay in Greenville hospital [Discharge Summary Notification]. A Discharge Summary Notification is also sent by the hospital to Mrs. Nuclear’s family physician.