Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T15:01:59.419Z Has data issue: false hasContentIssue false
  • English
  • Français

Pandemic Influenza Extension Areas in an Urban Pediatric Hospital

Published online by Cambridge University Press:  25 April 2012

Rachel L. Charney ,
Eric S. Armbrecht ,
Brian R. Kennedy  and
Robert G. Flood
Rachel L. Charney*
Affiliation:
Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri USA
Eric S. Armbrecht
Affiliation:
Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri USA Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri USA Center for Outcomes Research, Saint Louis University, St. Louis, Missouri USA
Brian R. Kennedy
Affiliation:
Cardinal Glennon Children’s Medical Center, St. Louis, Missouri USA
Robert G. Flood
Affiliation:
Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri USA
*
Correspondence: Rachel L. Charney, MD Department of Pediatrics St. Louis University School of Medicine1465 W. Grand Blvd. Saint Louis, MO 63104 USA E-mail: rcharney@slu.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction The 2009 H1N1 influenza pandemic created a surge of patients with low-acuity influenza-like-illness (ILI) to hospital Emergency Departments (EDs). The development and results of a tiered surge plan to care for these patients at a Pediatric Emergency Department (PED) were studied.

Hypothesis/Problem By providing standard assessment and treatment algorithms within physically separate ILI Extension Areas, it was hypothesized that patient care could be streamlined and the quality of care maintained.

Methods Hospital administrators created the tiered H1N1 surge plan within the framework of the existing emergency operations plan (EOP). After the initial expansion of space and staff utilization within the existing PED footprint, ILI Extension Areas were opened and staffed by non-ED physicians and nursing to provide care rapidly for ILI patients after Registered Nurse (RN) screening. Volumes, length of stay (LOS), left without being seen (LWBS) rates, patient satisfaction, and costs were tracked and measured.

Results Significantly elevated volumes of patients were seen in the months of September and October of 2009 (42.0% and 32.7% increase over 2008). During this time, 612 patients were triaged to the ILI Extension Areas. The LOS was similar to that experienced in prior years. The LWBS rates in September (4.8%) and October (3.4%) were slightly elevated over the 2009 yearly average (3.2%), but remained lower than during a prior, high-volume month. Satisfaction, measured as patients’ “likelihood to recommend,” remained within the range observed during other parts of the year. Cost estimates indicate favorable financial performance for the institution.

Conclusion The tiered surge response plan represented a success in managing large volumes of low-acuity patients during an extended period of time. This design can be utilized effectively in the future during times of patient surge.

Keywords

disaster preparednesshealth care costsH1N1influenzaPediatric Emergency DepartmentPress-Ganeysatisfactionsurge
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 1 , February 2012 , pp. 75 - 80
Copyright
Copyright Charney © World Association for Disaster and Emergency Medicine 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Joint Commission on Accreditation of Healthcare Organizations. 2006 Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Oakbrook Terrace, IL: Joint Commission Resources, 2006.Google Scholar
2.Rust, G, Melbourne, M, Truman, BI, et al. . Role of the primary care safety net in pandemic influenza. Am J Public Health. 2009;99 Suppl 2:S316–323.CrossRefGoogle ScholarPubMed
3.Iversen, GR, Norpoth, H. Analysis of Variance. 2nd ed. Newbury Park, California, USA: Sage Publications;1987:94.CrossRefGoogle Scholar
4.Dawson, B, Trapp, RG. Basic and Clinical Biostatistics. 4th ed. New York: Lange Medical Books/McGraw-Hill; 2004:438.Google Scholar
5.Norman, GR, Streiner, DL. Biostatistics: The Bare Essentials. 2nd ed. Hamilton, Ontario, Canada: B.C. Decker; 2000: 324.Google Scholar
6.Bradt, DA, Aitken, P, Fitzgerald, G, et al. . Emergency department surge capacity: recommendations of the Australasian surge strategy working group. Acad Emerg Med. 2009;16(12):1350–1358.CrossRefGoogle ScholarPubMed
7.Asplin, BR, Flottemesch, TJ, Gordon, BD. Developing models for patient flow and daily surge capacity research. Acad Emerg Med. 2006;13(11):1109–1113.CrossRefGoogle ScholarPubMed
8.Hood, J, LaCoe, . The roles of the occupational health nurse and infection control in managing a novel H1N1 surge--lessons from the front line. AAOHN J. 2009;57(9):355–358.Google Scholar
9.Cruz, AT, Patel, B, DiStefano, MC, et al. . Outside the box and into thick air: implementation of an exterior mobile pediatric emergency response team for North American H1N1 (swine) influenza virus in Houston, Texas. Ann Emerg Med. 2010;55(1):23–31.CrossRefGoogle Scholar
10.Cooper, MC, Walz, K, Brown, MG, et al. . Boston Medical Center Pediatric Emergency response to H1N1. J Emerg Nurs. 2009;35(6):580–583.Google Scholar
11.Roszak, AR, Jensen, FR, Wild, RE, et al. . Implications of the Emergency Medical Treatment and Labor Act (EMTALA) during public health emergencies and on alternate sites of care. Disaster Med Public Health Prep. 2009;3(Suppl 2):S172–175.CrossRefGoogle ScholarPubMed
12.Pines, JM, Garson, C, Baxt, WG, et al. . ED crowding is associated with variable perceptions of care compromise. Acad Emerg Med. 2007;14(12):1176–1181.Google Scholar