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Public Health Nursing Project Enhances Solutions at Hospitals

Delays in reporting public health threats can contribute to widespread outbreaks. Public health nurses are addressing this need for agency collaboration and job training.

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Emerging infections such as severe acute respiratory syndrome (SARS), West Nile virus, and other emerging infectious diseases, as well as bioterrorism pose increasing threats to public health. Delays in reporting could contribute to widespread outbreaks. Yet traditionally, communication between Public Health and hospitals has been fragmented.

Despite state and local laws requiring medical providers to report communicable diseases to the local public health department, reporting is incomplete.

Liaison Public Health Nurse Project

The LAC Department of Health Services (LACDHS) is the largest public health jurisdiction on the Pacific Coast and the second largest in the US. The Los Angeles County has launched the Liaison Public Health Nurse Project to integrate public health goals into the hospital setting. The use of trained public health nurses as hospital liaisons has improved communication and disease reporting.

Los Angeles County is the only local health department in the nation to implement such a project.

Created in November 2003, the Hospital Outreach Unit is now an integral component of the public health link to community healthcare agencies.

The origins of the Liaison Public Health Nurses Project began during the SARS epidemic in early-2003. The Liaison Public Health Nurses (LPHN) assisted with managing suspect SARS cases and working with the hospitals to ensure infection control was maintained. After the SARS situation had passed, it became clear that there was a need for a new hospital unit in ACDC. In November 2003, ACDC instituted the Hospital Outreach Unit (HOU). This unit provided liaison with all hospitals in LAC to increase traditional disease reporting as well as enhance emerging infectious disease preparedness.

The mission of the Hospital Outreach Unit is to enhance emerging infectious disease preparedness and response efforts and improve hospital disease reporting by hospitals in LAC through strengthened communications, collaboration, and consolidation of resources.

The Liaison Public Health Nurse Project is now expanding to non-hospital healthcare settings, such as large clinics and jails.

What Best Practices Need to be Developed in Hospitals?

1) disease reporting

2) regulations surrounding discharge of clients with communicable diseases to continuing care facilities

3) clinical manifestations of relevant diseases

4) the role of public health through training sessions and/or informational materials

What solutions improve public health in hospitals?

Web-based Confidential Morbidity Report (Web CMR) is offered to all LAC hospitals including hospitals in Long Beach and Pasadena jurisdictions.

An enhanced West Nile virus (WNV) Surveillance project was conducted and selected as sentinel surveillance sites for encephalitis focusing on WNV infection. LPHNs facilitated laboratory testing processes, communications with hospitals and physicians and conducted patient interviews.

They provided recommendations regarding worksite planning and the connection between employee absenteeism and disease surveillance.

The Hospital Outreach Unit assesses the timeliness and completeness of disease reporting from four syndrome categories: rash, gastrointestinal, respiratory, and neurological. The data from these assessments will provide a baseline of the current state of disease reporting in LAC and can be used to target resources to make improvements to the disease reporting system.

LPHNs investigate suspect deaths and review Coroners' reports to identify data about diseases that may not have been reported through other sources.

What weaknesses need to be addressed?

Prominent weaknesses and barriers relating to disease reporting are:

1) unclear disease reporting procedures (e.g., to which jurisdiction to report, which diseases to report, what constitutes as an outbreak)

2) difficulty with faxing documents repeatedly to different LAC departments/units

3) most hospital departments, including some outpatient clinics, heavily rely on the ICPs to report cases which often overwhelms the ICPs

4) lack of knowledge of resources available from the county programs.

Inadequate disease reporting and lack of positive relationships between public health and hospitals may lead to:

  • Propagation of disease throughout the county
  • Ineffective interventions
  • Delayed recognition of a possible bioterrorism event
  • Ineffective response or other public health emergency
Putting best practices in place with cross-department and agency collaboration can reduce these threats to public health.

CONTACT:
Liaison Public Health Nurse Project
Sharon Sakamoto
Program Specialist
313 N. Figueroa St., Room 212
Los Angeles, CA 90012
Phone: 213/240-7941
E-mail: ssakamoto@ph.lacounty.gov

Edited by Carolyn Allen
| public health | disaster | disease | healthcare |

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