AFTER ACTION REVIEW AS A TOOL TO IMPROVE A TERTIARY HOSPITAL’S RESPONSE TO OUTBREAKS: EXPERIENCE FROM IRRUA SPECIALIST TEACHING HOSPITAL

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J. Okoeguale¹, E. Tobin¹, C. Erameh¹, E. Ogbaini-Emovon¹, S.A Okogbenin¹, D.A Asogun¹, C. Erohubie¹, O Edeawe¹, M. Okonofua¹, P.O Okokhere¹, G.O Akpede¹, RA Eifediyi^1,2, S. Izevbekhai¹

1. Institute of Viral and Emergent Pathogens Control and Research.
2. Department of Obstetrics and Gynecology, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.

INTRODUCTION

After-action reviews serve as a leadership and knowledge-sharing tool, assembling the team most closely involved in an activity or project upon reaching a pivotal milestone. These sessions facilitate open and honest discussions about both successes and failures. The primary aim is to glean insights from the experience and apply them to improve subsequent phases of the project or related tasks. While after-action reviews and retrospects are conceptually connected, they differ in the level of detail and formality applied during their execution.

Lassa fever (LF) outbreaks in Nigeria occur yearly with growing incidence and increasing geographical spread. In high-burden states, the outbreak occurs all year round, with a seasonal surge in cases between December and April. The changing dynamics of the disease in recent years led the World Health Organization to designate it a priority disease for research and development of new therapeutics, diagnostics and vaccines.

Irrua Specialist Teaching Hospital (ISTH) was declared a centre of excellence for the management of LF in 2011 and since then, the hospital has been a referral centre for diagnostics, surveillance and treatment in the state and neighbouring states.

On the 5th of January 2023, the upsurge in cases from the preceding month led the State Ministry of Health to declare an outbreak with the activation of the State Lassa Fever Emergency Operations Centre (EOC). A robust state-wide response was activated using the One Health approach and the involvement of the Nigeria Centre for Disease Control (NCDC) and partners, notably the World Health Organisation (WHO).

ISTH has been at the centre of the LF outbreak response for several years, and in the 2023 outbreak supported the PHEOC in the areas of laboratory testing, case management, surveillance, data management and infection prevention and control (IPC). Early in the outbreak, the ISTH response team identified what is now referred to as the 9 “Ls” of mortality, viz

1. Low index of suspicion
2. Late collection of blood samples
3. Late diagnosis
4. Late referral
5. Late presentation
6. Late initiation of therapeutic measures
7. Late dialysis support
8. Late availability of blood products
9. Low financial/family support

The outbreak was declared over by the State PHEOC on the 10th of May 2023, nevertheless, the ISTHcontinued to receive and treat confirmed cases of Lassa fever.

Under the International Health Regulations (IHR) monitoring and evaluation framework, after action reviews (AAR) are encouraged to be conducted after any response to public health emergencies to learn from the response and improve preparedness and response to future outbreaks/and other public health emergencies. It was on this premise that the Irrua Specialist Teaching Hospital conducted the Lassa fever AAR meeting to identify best practices and challenges encountered during the response, validate existing mechanisms and identify areas for improvement to achieve the hospital’s goal of a one-digit case fatality from Lassa fever.

The goal of the AAR was to scrutinize the institution’s response to the 2023 outbreak, identifying best practices and areas for improvement, and developing workable strategies to better prepare the institution for future outbreaks whilst identifying interventions to reduce mortality and morbidity from Lassa fever.