Case Management Storyboard 2: Meningococcal Meningitis Case

Case Management Storyboard to Illustrate TB Surveillance.

Annie Nuclear has just been admitted to Greenville hospital. Dr. Admit has not yet received the laboratory results, but based on clinical findings he believes this to be a suspect case of Meningococcal Meningitis (MM). The doctor sends an [Investigation Request] to the local public health unit indicating that lab tests have been ordered but no results are available yet.

Nightingale accepts the investigation request [Investigation Request Promise Response]. She creates a “suspect” case for Annie and then follows up by sending the hospital a [Care Plan Request] message. This message requests that the hospital place Annie on respiratory isolation until 24 hours after the commencement of treatment.

Nightingale goes to the hospital to see Annie and initiates contact tracing. Annie identifies sixteen people (all within her extended family) with whom she’s recently shared meals. Nightingale records these individuals as close contacts of this case.

In the meantime Nightingale receives confirmation of MM from the Laboratory [Laboratory Result Notification]. The Lab has sent these results to Public Health because this is a notifiable condition. (If the results had been negative, they would not have notified Public Health and Nightingale would have to search for the lab results herself.) Nightingale updates Annie’s case from a “Suspected” to “Confirmed” case of MM. Nightingale sends a [Care Plan Notification] to Annie’s family physician to inform him of the hospital admission and subsequent diagnosis and to advise the physician that Public Health is intervening.

Nightingale has been waiting for this laboratory confirmation before arranging chemoprophylaxis for the contacts she identified from Annie’s interview. There are too many contacts for Public Health to manage alone, so she enlists the aid of family physicians. She sends a [Care Plan Request] to the family physicians of each the case contacts. The request states that their client has been identified as a close contact for a MM case and that he/she requires chemoprophylaxis. The doctors are provided with information on how to access the necessary medications/immunization, through Public Health services.

Serotyping of the organism of the index case (which happens to be Annie), indicates that an immunization is advisable as an adjunct to the prophylaxis medications being given to the case contacts. Public Health would normally order and administer the immunizations, but there are too many individuals involved in here. An additional [Care Plan Request] is therefore sent to each contact’s family doctor, requesting that the immunization be administered.

In the meantime, Nightingale has been querying the neighbouring public health case management systems and determined that two days previously, Blueville health unit recorded an MM case (Johanna) with Annie’s university listed as the exposure site [Case Candidate Query/Response] + [Case Detail Query/Response]. Nightingale re-interviews Annie. Annie had forgotten to inform Nightingale that she had shared a water bottle with Joanna, a member of the opposing team from Blueville.

Nightingale compares Joanna’s case with Annie’s. She learns that the laboratory results, for both Annie and Johanna, show a similar disease serotype suggesting that these two cases are related. Nurse Nightingale links Johanna’s case to Annie’s list of contacts.

While she is still in the hospital, Dr. Admit discovers that Annie also has Syphilis. During the Public Health investigation Nightingale uncovers the fact that Annie donated blood during a time when this infection could have been transmitted to others via her blood. Nightingale therefore reports this to the National Blood Services [Investigation Request]. The Request contains the following information:

• Explicit identification of the person (name, dob)
• Type of Disease

• Where blood was taken (for the donation) • Blood vs blood products • Location of Donor Clinic • Lab results confirming the disease