Rapid identification and isolation of patients with highly infectious diseases is critical in today's hospital environments. This study focused on the development of a digital screening tool for screening patients during a measles outbreak in New York City using a complimentary and publicly available digital survey application. Because of their ease of use and distant location compliance monitoring capabilities, the results show that digital tools are a viable alternative to paper tools. The Identify, Isolate, and Inform (3I) approach has become a standard algorithm used in hospital settings for the rapid identification and treatment of patients with a potentially highly infectious disease.

These actions taken during the first few minutes of a patient encounter were developed during the Ebola crisis and have since been used and adapted for new and re-emerging diseases such as measles and MERS. With the recent emergence of COVID-19, healthcare facilities must now identify patients with highly infectious diseases quickly and effectively. This study focuses specifically on improved patient screening for measles. Measles symptoms include a rash, fever, cough, coryza, and conjunctivitis. It is particularly hazardous to unvaccinated babies and young children.

During the maximum of the outbreak in April 2019, the New York Department of Health emphasised the importance of hospitals performing enhanced screening to quickly identify and isolate measles patients. To meet this request, the Infection Prevention Department of a large health system collaborated with several other hospital departments to design and implement a digital measles screening tool. To identify patients at risk for measles, a screening tool was developed using a free and publicly available digital survey application. The tool was administered by healthcare personnel to patients near healthcare facility entrances, and it asked questions about measles symptoms, vaccination history, exposure history, and residence in high risk areas. No personally identifiable information about the patients was registered into the tool.

The tool used an automated debate method that resulted in one of two outcomes: placing a surgical mask on the patient and immediately informing clinical staff to perform a further risk assessment; or allowing the patient to proceed with their visit. Security and other front-line personnel were given tablets or computers and trained on how to use them. Infection Prevention staff routinely used the digital application's remote monitoring features to electronically monitor tool use, and provided feedback over the three-month enhanced screening time period to promote compliance. Data was exported from the digital application for later analysis. Between 4/25/19 and 8/4/2019, approximately 59,435 patients were surveyed using the digital measles screening tool. 91 (0.15%) of these patients were identified as high risk and required further evaluation by clinical staff to rule out measles. None of the 91 patients later tested positive for measles.

During the intervention period, no cases of confirmed measles were reported at the screening sites. The large number of survey responses received during the intervention period indicated that healthcare personnel were able to successfully use the digital measles tool to screen patients at healthcare facility entrances. Only a small percentage (0.15%) of the large number of patients screened were identified as being at risk for measles. The majority of these flagged patients (65.9%) had a fever and a rash. The small number of patients who were identified suggested that the tool was not overly sensitive. which might have resulted in high level of stress workers and a traffic delay at the healthcare institution entrances In comparison to typical paper tools and flowcharts for patient screening, the digital tool developed in this intervention found to be easier for staff to use due to the included as algorithm feature in the digital survey application. While some electronic medical records include decision support tools for patient screening, these electronic medical record capabilities can be costly and are frequently only available to clinical staff positioned away from healthcare facility doors. Because free digital survey applications are simple to use, any healthcare employee (security, concierges, etc.) stationed at the first point of entry can screen patients and immediately isolate them before they enter the facility. A few concerns were identified during the implementation of the digital survey intervention.

The first problem was getting nonclinical personnel on side with implementing the digital tool. Furthermore, these staff members may be taken away from patient screening to handle other essential work, such as a security problem. These obstacles were partially resolved by collaborating with management to routinely emphasise the benefits of patient screening with front-line employees. Furthermore, the digital tool's remote monitoring capabilities allowed for intervention with personnel when large time gaps between survey responses were observed. Because of their simplicity of use by nonclinical staff working near healthcare facility admissions and their distant compliance monitoring capabilities, the intervention results show that digital survey applications are effective alternatives to other infectious disease screening approaches. Digital survey apps hold potential for the early detection and isolation of people with highly contagious diseases such as COVID-19 who enter healthcare institutions.

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Margaret Jones
Journal of Tourism & Hospitality
ISSN: 2167-0269