Health Departments Slow to Respond to Disease Outbreaks

WEDNESDAY Jan. 2, 2008 -- Doctors or nurses reporting a potentially dangerous infectious disease outbreak may find themselves on hold with their local health department for an hour or more, a new phone survey finds.

That hold time applies only when someone actually picks up -- researchers could not get through on at least one call testing the disease-reporting hotline of two out of five health departments.

Only one in three local health departments connected the researchers -- who portrayed themselves as medical professionals reporting a possible disease outbreak -- with a trained public health professional within 30 minutes.

A timely response is necessary in the event of a disease outbreak, said the team from the Rand Corporation, an independent health policy research program. At the time the research was done, the U.S. Centers for Disease Control and Prevention recommended that a trained public health professional be available to take the confidential details of any outbreak in less than 30 minutes from the time the phone is answered.

For the study, conducted between May and October 2006, the research team placed five to 10 unannounced tests on the telephone-based disease-reporting systems of a representative sample of 74 local health departments nationally. They placed a total of 596 calls posing as a local doctor or nurse seeking to report an urgent, confidential infectious disease case to a trained public health professional.

When the callers reached the public professional, they said the call was just a test, and no further action was needed.

The callers were on hold an average of 63 minutes before they were able to talk to a trained professional, according to the study, published in the February edition of the American Journal of Public Health. The callers were unable to get through at least once to 40 percent of the health departments. However, 31 percent of the departments connected the callers to a trained health professional in under half an hour.

In one case, the researchers in the survey reported waiting more than 16 hours and 43 minutes to speak to a trained health professional.

"These are complex systems, and there are a number of places where the system can break down," David J. Dausey, lead author of the report and an associate policy researcher at Rand, said in a prepared statement. "If you have a single individual responsible for ensuring the call gets evaluated properly, it appears to be more effective than an electronic system where you have to 'press one' to reach this person or 'press two' to leave a message. If someone is out of the office that day, for example, it could lead to problems."

The researchers argued that appropriate training and a standard protocol are both necessary for people responding to phone calls reporting infectious disease outbreak.

Dausey noted that since the study was conducted, the CDC has shortened its guidelines for reaching a trained public health professional from 30 minutes to 15 minutes.

More information

To learn more about infectious disease reporting, visit the U.S. Centers for Disease Control and Prevention.

Posted: January 2008


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