No-Notice Mystery Patient Drills to Assess Emergency Preparedness for Infectious Diseases at Community Health Centers in New York City, 2015–2016

  • Mohsin AliEmail author
  • Marsha D. Williams
Original Paper


Mystery patient drills using simulated patients have been used in hospitals to assess emergency preparedness for infectious diseases, but these drills have seldom been reported in primary care settings. We conducted three rounds of mystery patient drills designed to simulate either influenza-like illness (ILI) or measles at 41 community health centers in New York City from April 2015 through December 2016. Among 50 drills conducted, 49 successfully screened the patient–actor (defined as provision of a mask or referral to the medical team given concern of infection requiring potential isolation), with 35 (70%) drills completing screening without any challenges. In 47 drills, the patient was subsequently isolated (defined as placement in a closed room to limit transmission), with 29 (58%) drills completing isolation without any challenges. Patient–actors simulating ILI were more likely to be masked than those simulating measles (93% vs. 59%, p = 0.007). Median time to screening was 2 min (interquartile range [IQR] 2–6 min) and subsequently to isolation was 1 min (IQR 0–2 min). Approximately 95% of participants reported the drill was realistic and prepared them to deal with the hazards addressed. Qualitative analysis revealed recurring themes for strengths (e.g., established protocols, effective communication) and areas for improvement (e.g., hand hygiene, explaining isolation rationale). We conclude that mystery patient drills are an effective and feasible longitudinal collaboration between health departments and primary care clinics to assess and inform emergency preparedness for infectious diseases.


Emergency preparedness Community health centers Infectious diseases Drills 



This research was exempted as not human subjects research by the New York City Department of Health and Mental Hygiene (#17-037). The project was funded by the New York City Department of Health and Mental Hygiene (NYC DOHMH), supported by Grant 1U90TP000546 from the United States Department of Health and Human Services (HHS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NYC DOHMH or HHS. The authors report no conflict of interest concerning the materials or methods used in this study or the findings reported in this paper. We are grateful to several people and organizations whose involvement was integral to this study, including the New York City Medical Reserve Corps and Primary Care Emergency Preparedness Network (PCEPN)—comprised of the Community Health Care Association of New York State (CHCANYS) as well as, previously, Primary Care Development Corporation (PCDC). Celia Quinn was a supportive mentor throughout. Jannae Parrot helped coordinate the IRB approval process. Sandhya George, Margaret Millstone, Pooja Jani, Darrin Pruitt, and Elizabeth Selkowe edited earlier versions of this manuscript. Finally, we thank the clinical and administrative staff of participating clinics. This paper was presented as an oral presentation at the 2017 Annual Meeting of the American Public Health Association in Atlanta, Georgia, in November 2017.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Bureau of Healthcare System Readiness, Office of Emergency Preparedness and ResponseNew York City Department of Health and Mental HygieneQueensUSA
  2. 2.Icahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Department of MedicineBoston Children’s HospitalBostonUSA
  4. 4.Department of PediatricsBoston Medical CenterBostonUSA

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