Review of the Genesis of the Yellowknife Tuberculosis Outbreak 2007 Ewan Affleck Medical Director YHSSA Circumpolar Rounds Stanton Territorial Hospital Yellowknife, NT January 7, 2010 http://ichr.ca

1. REVIEW
OF
THE
GENESIS
OF
THE
YELLOWKNIFE
TUBERCULOSIS
OUTBREAK
2007
Ewan
Affleck
Medical
Director
YHSSA
Director
of
Family
Medicine
STHA
ICHR
–
Yellowknife,
July
2009

2. TB
OUTBREAK
IN
YELLOWKNIFE
-­‐
2007
• Index
case
sought
medical
attention
7
months
before
positive
identification.
• Diagnosed
with
highly
infectious
strain
of
TB.
• Index
case
has
contact
with
over
700
people.
• 16
cases
of
active
TB
resulted
from
this
outbreak.
• Significant
upfront
and
long-­‐term
costs
to
the
health
care
system.
• Subsequent
changes
made
/
snapshot
from
2007

3. Research
Project
• Team:
Brenda
Kolasa
–
PH
Nurse,
Candy
Grimm
–
NP,
Cherie
Shae
–
NP,
Christine
Scott
–MD,
Dave
Pontin
–
MD,
Ewan
Affleck
–
Medical
Director
&
Project
Lead,
Jo-­‐Anne
Hubert
–
Director
of
NP
Program,
Lorrie
Parton
–
Director
of
PH
YHSSA,
Ruth
Robertson
–
CEO
YHSSA
• Method:
Tracer
Methodology
–
2
cases
(2007
&
2003)
• Context:
Fanning
Reports
of
2001
&
2006

4. Deputy
Minister
of
Health
Chief
Medical
Health
Officer
Population
Health
TB
statistics
/
Nursing
station
support
Stanton
Territorial
Health
Authority
Other
Yellowknife
Health
Health
&
Social
Services
Authorities
Authority
(YHSSA)
BDHSSA
Regional
0.2
FTE
Environmental
Medical
Health
MHO
Primary
YHSSA
Health
health
care
Public
Officer
workers
Health
Unit

5. WHO
PROVIDED
THE
CARE
TO
THE
INDEX
CASE?
3
clinic
based
physicians
2
radiologists
3
hospitalists
1
Medical
health
officer
1
Public
health
nurse
1
ER
physician
1
Nurse
Practitioner
1
Otolaryngologist
___________________
TOTAL:
13
HEALTH
CARE
PROFESSIONALS

6. Chief
Medical
Health
Officer
Population
Health
TB
statistics
/
Nursing
station
support
Stanton
Territorial
Health
Authority
Other
Yellowknife
Health
Health
&
Social
Services
Authorities
Authority
(YHSSA)
BDHSSA
Regional
0.2
FTE
Primary
Environmental
Medical
Health
MHO
health
care
YHSSA
Health
workers
Public
Officer
Health
Unit
Index
Case

7. Chief
Medical
Health
Officer
Population
Health
TB
statistics
/
Nursing
station
support
Stanton
Territorial
Yellowknife
Health
Health
Authority
&
Social
Services
Authority
(YHSSA)
Regional
Medical
Primary
YHSSA
Health
health
care
Public
Officer
workers
Health
Unit
Index
Case

8. What
Happened?
OPERATIONAL
GOVERNANCE
• Everyone
involved
acted
• Structural
obstacles
upon
the
information
they
• Cultural
obstacles
had
• Lack
of
integration
• Cognitive
bias
• Lack
of
system
wide
• Multiple
errors
of
standards
assumption
/
• Lack
of
accountability
communication
• Coordination
• Lack
of
standards
and
set
roles
&
responsibilities.

9. Findings
of
Naylor
Report
• Lack
of
surge
capacity
in
the
clinical
and
public
health
systems
• “Dysfunctional”
relationships
between
various
orders
of
governments
and
ill-­‐
coordinated
responses
to
SARS
• Absence
of
protocols
for
data
or
information
sharing
among
levels
of
government
and
uncertainties
about
data
ownership
• Lack
of
coordinated
business
processes
across
institutions
• Inadequacies
in
institutional
outbreak
management
protocols
• Weak
links
between
public
health
and
personal
health
services
including
primary
care,
institutions
and
home
care

10. Conclusion
“From
Research
to
Action”
• Governance
• Standards
• Accountability
• Relationships

12. Questions?