(FACILITY NAME) Mystery Patient Drill
Action Report and Improvement Plan
(TEMPLATE)
DATE
Handling Instructions
The information gathered in this After Action
Report (AAR) is classified as For Official Use
Only (FOUO) and should be handled as
sensitive information not to be disclosed. Items
may not be discarded un-shredded in open
trash.
Authorship/Points of Contact
Table of Contents
Preface .......................................................................................................................................................... 3
Handling Instructions .................................................................................................................................... 4
Exercise Summary ......................................................................................................................................... 5
Major Strengths ........................................................................................................................................ 5
Primary Areas for Improvement ............................................................................................................... 5
Exercise Overview ......................................................................................................................................... 6
Exercise Design Summary ............................................................................................................................. 7
New York City Department of Health and Mental Hygiene (NYC DOHMH)
Summary ................................................................................................................................................... 7
Control and Evaluation ............................................................................................................................. 7
Scenario Summary .................................................................................................................................... 7
Exercise Evaluation Guide: ........................................................................................................................ 8
Time Study Findings: ............................................................................................................................... 11
Arrival Findings: ...................................................................................................................................... 11
Strengths: ............................................................................................................................................ 11
Observations: ...................................................................................................................................... 11
Infection Control Findings: ...................................................................................................................... 11
Strengths: ............................................................................................................................................ 11
Observations: ...................................................................................................................................... 11
Isolation Findings: ................................................................................................................................... 11
Strengths: ............................................................................................................................................ 11
Appendix A – Improvement Plan ................................................................................................................ 12
Appendix B– Drill Sign-In Sheet................................................................................................................... 13
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Preface
This After Action Report (AAR) adheres to guidance provided by the US Department of Health and
Human Services Assistant Secretary for Preparedness and Response (HHS-ASPR). The following HHS-
ASPR capabilities and functions are addressed in this exercise:
Capability 1: Healthcare System Preparedness
Function 4: Determine gaps in the healthcare preparedness and identify resources
for mitigation of these gaps.
Function 6: Improve healthcare response capabilities through coordinated exercises
and evaluation.
The Mystery Patient Drill is an unclassified exercise; however, due to operational sensitivity all exercise
materials are determined to be For Official Use Only (FOUO).
All exercise participants should use appropriate guidelines to ensure proper control of information
within their areas of expertise to protect this material in accordance with current jurisdictional and
organizational directives.
Mystery Patient Drill – After Action Report/Improvement Plan
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Handling Instructions
1. The title of this document Mystery Patient Drill After Action Report and Improvement Plan (AAR).
2. The information gathered in this AAR is For Official Use Only (FOUO) and should be handled as
sensitive information not to be disclosed. This document should be safeguarded, handled,
transmitted and stored in accordance with appropriate security directives.
3. At a minimum, the attached materials will be disseminated only on a need-to-know basis and when
unattended, will be stored in a locked container or area offering sufficient protection against theft,
compromise, inadvertent access or unauthorized disclosure.
4. For more information, please consult with the following points of contact:
List POCs
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Exercise Summary
The Mystery Patient Drill is designed to test the hospital’s capabilities to rapidly identify, isolate and
assess potential patients with Ebola Virus Disease (EVD) or other infectious diseases of public health
concern.
During three exercise design meetings held in the summer and early fall of 2015, NYC DOHMH and the
Stakeholder Advisory Group developed the following drill objectives:
Objective 1: Determine the time it takes the facility to identify a potential patient with EVD or
other highly infectious disease and begin exposure mitigation procedures in the emergency
department (ED) triage area.
Objective 2: Identify the amount of time taken for the patient to be transferred to an isolation
room.
Objective 3: Assess staff adherence to key infection control measures.
Objective 4: Determine facility capability to make the necessary internal notifications and report
the need for notification to DOHMH (notional).
This report provides an analysis of drill results and identifies strengths and areas for improvement. The
AAR is intended to inform and ground the Improvement Plan developed by the hospital.
Major Strengths
List
Primary Areas for Improvement
List
Overall, the staff (DID OR DID NOT) demonstrated the ability to identify, isolate and assess the potential
patient described in this scenario. Based on the findings from the drill the hospital should continue to
collaborate with your Health Department and its partners to improve their capability to handle
potentially highly infectious disease through continued training, exercise, evaluation and reporting.
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Exercise Overview
Exercise Name
Mystery Patient Drill
Date of Exercise
Start Time
End Time
Type of Exercise
Drill
Exercise Sponsor
Exercise Location
Exercise Purpose
The exercise described herein was intended to test the ability of the hospital to
rapidly and safely identify, isolate and assess potential patients with EVD or other
diseases of public health concern.
Exercise Scope
The drill was planned for no more than two hours at acute care hospital
emergency departments. Exercise play began when the controller (patient)
entered the emergency department and ended at the point of initial evaluation
and decision to notify the Health Department.
Exercise Objectives
Determine the time it takes the facility to identify a potential patient with
EVD or other highly infectious disease and begin exposure mitigation
procedures in the emergency department triage area.
Identify the amount of time taken for the patient to be transferred to an
isolation room.
Determine facility capability to make the necessary internal notifications
and report the need for notification to the Health Department (notional).
Exercise Scenario
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Exercise Design Summary
Summary
The drill tests the participating acute care hospital’s ability to rapidly identify, isolate and assess a
potential patient with EVD or other infectious disease of public health concern. To this end, specific
targets were based on guidance issued by NYC DOHMH to acute care hospitals in the city. NYC DOHMH
developed the structure of the drill and all associated materials with input from a Stakeholder Advisory
Group (SAG), whose membership consisted of representatives from NYC DOHMH and acute care
hospitals within the city (a full list of SAG membership is available in Appendix C).
Control and Evaluation
Exercise staff consisted of a controller, an evaluator and at least one trusted agent from the facility. The
controller was the exercise-designated “patient” at the facility’s emergency department and presented
with symptoms consistent with the exercise scenario. The exercise controller retained the right to
terminate exercise play at any point due to safety concerns or real world events that may otherwise
have interfered with exercise play. The exercise controller assisted in data collection activities wherever
practical and did so in a manner that maintained the unannounced intention of the drill.
The evaluator collected data and provided feedback based on the exercise objectives and the exercise
evaluation guide (EEG, see Appendix B). The EEG captured both qualitative measures (e.g., presence of
appropriate personal protective equipment, questions asked of the patient, etc.) and quantitative
measures (e.g., time taken to identify the patient and isolate them, etc.).The evaluator was positioned in
the emergency department at all times during exercise play and maintained view of the controller
whenever possible without otherwise interfering during the drill.
At least one staff person at the facility was selected to serve as a trusted agent. Exercise staff informed
the trusted agent of the expected date and time of the drill. In turn, the trusted agent advised the
controller and evaluator of any unique facility-specific considerations, applicable plans, and other events
that were scheduled on the day of the exercise. As an employee of the facility playing in the drill, the
trusted agent(s) retained the right to terminate the exercise.
Scenario Summary
Each drill conducted through this initiative utilized one of three possible scenarios developed by the
SAG. The scenarios involved either an adult or pediatric patient presenting with symptoms consistent
with EVD, measles virus or Middle East Respiratory Syndrome (MERS). This drill used the following
scenario:
INSERT SCENARIO
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Exercise Evaluation Guide:
Facility:
Date:
Controller:
Scenario:
Evaluator:
Start Time:
Trusted Agent:
End Time:
Key Measures
Time Stamp
Time patient entered the Emergency Dept.:
Time patient brought to screening/triage:
Time charge nurse/supervisor notified by triage:
Time patient dons mask (or other source control measure is initiated):
Who gave the patient a mask?
Greeter
Security
Receptionist
Triage staff
Physician/PA/NP
Other: __________________
Was this the first staff member the patient came into contact with?
Yes
No
Unsure
Not applicable (patient not given a mask)
If other initial source control measures were taken besides
masking, please
specify:____________________________________
Time the patient is moved to isolation room:
Time facility’s Infection Control is notified:
Time Health Department is notified (notional):
Entry and Screening Questions
Y
N
N/A
Was there visible signage concerning precautions for patients entering
with highly communicable disease?
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Upon arrival, with whom did the patient first come in contact?
Greeter
Guard
Receptionist/Registrar
Triage personnel
Other (please specify):
____________________________________
Was patient screening conducted by the FIRST ED staff person with whom
the patient had contact (e.g. guard, registrant, triage nurse)?
If not, who did the initial patient screening?
Receptionist/Registrar
Triage personnel
Other (please
specify):_________________________________
Risk Screening Questions
Was the patient asked if they had a fever within the past two weeks?
If the patient reported a fever, were they asked if they had a rash or
unusual skin lesion?
If the patient reported a fever, were they asked if they or someone
close to them had traveled outside the US?
Was the patient asked about the presence of respiratory symptoms?
Was a standardized questionnaire used to screen the patient for the above
symptoms? (paper form or in EMR)
Was a nurse or supervisor promptly notified of a screened positive
patient?
Did hospital staff use an expedited/abbreviated registration process to
limit patient contact with staff and other patients?
Was patient screened to a “fast track” and/or Urgent Care area separate
from the main ED?
Infection Control Questions
Are masks visible and available to patients in the waiting area?
Are hand hygiene supplies visible and available in the patient waiting area?
Was the screened positive patient given a mask and appropriate
instruction?
Was hand hygiene performed by all staff who came in contact with
patient?
Was the patient instructed to perform hand hygiene after coughing or
after coming in contact with respiratory secretions or rash?
Were other ED staff notified of a screened positive patient?
Was Infection Control notified?
Isolation Questions
Was the designated isolation room available?
Was the patient placed in an Airborne Infection Isolation Room (AIIR)?
If the isolation room is unavailable, was the patient physically separated
Turn Over
Turn Over
Turn Over
Turn Over
Turn Over
Turn Over
Turn Over
Turn Over
Turn Over
Turn Over
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from other patients?
Was appropriate Infection Control signage posted for the isolation room?
Did all staff entering the isolation room don the correct PPE (including
mask, gloves and gown if indicated)?
Were PPE supplies readily available near the isolation room entrance?
Did the provider wash/sanitize hands after patient encounter?
Notes
Including additional observations on strengths, challenges and deficiencies
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Time Study Findings:
Measure
1
Actual Time
Target Time
Met (Yes or No)
Time from patient presentation
to donning a mask (initial
source control
implementation)
2
Less than or equal to 60
seconds
3
Time from triage identification
to placement in isolation room
Less than or equal to 10
minutes
4
Entry and Screening Findings:
Strengths:
Observations:
Observation/Analysis/Recommendation
Infection Control Findings:
Strengths:
Observations:
Observation/Analysis/Recommendation
Isolation Findings:
Strengths:
Observations:
Observation/Analysis/Recommendation
1
As outlined in the Hospital Preparedness Program (HPP) Measure Manual: Implementation Guidance for Ebola Preparedness Measures (July
2015)
2
Initial source control refers to implementation of isolation precautions which may include masking of patient or separating patient from other
patients/staff or placement in a room away from other patients (e.g. triage, isolation room)
3
Time, in seconds, from patient’s arrival to placement in isolation (Goal: less than or equal to 60 seconds). Note: this metric is designed for
Ebola patients under active/direct active monitoring treated at assessment hospitals but has been identified during exercise planning as a
target for all hospitals by NYC DOHMH for the highly infectious diseases under review in this exercise series.
4
Time, in minutes, it takes a hospital to identify and isolate a patient with Ebola or other highly infectious disease (e.g., MERS-CoV, measles,
etc.) following emergency department triage.
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Appendix A – Improvement Plan
Area for
Improvement
Recommendation
Corrective
Action
Responsible
Party
Point of Contact
Start Date
End Date
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Appendix B– Drill Sign-In Sheet
Facility:
Date:
Time:
Name
Title
