Pandemic influenza extension areas in an urban pediatric hospital
Rachel L Charney1, Eric S Armbrecht, Brian R Kennedy
1Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri 63104, USA. rcharney@slu.edu
Insights
A tiered surge plan effectively managed increased patient volumes during the 2009 H1N1 pandemic. This strategy maintained care quality and financial performance in a pediatric emergency department.
Area of Science:
- Emergency Medicine
- Public Health
- Infectious Disease Epidemiology
Background:
- The 2009 H1N1 influenza pandemic led to a significant increase in emergency department (ED) visits for influenza-like-illness (ILI).
- Hospitals needed strategies to manage surges in low-acuity patients without compromising care quality.
Purpose of the Study:
- To evaluate the effectiveness of a tiered surge plan implemented in a pediatric emergency department (PED) during the H1N1 pandemic.
- To assess the impact of the plan on patient flow, care quality, and operational efficiency.
Main Methods:
- A tiered surge plan was developed using the existing emergency operations plan (EOP).
- Physically separate ILI Extension Areas were established, staffed by non-ED personnel, for rapid assessment and treatment of ILI patients post-RN screening.
- Key metrics including patient volume, length of stay (LOS), left without being seen (LWBS) rates, patient satisfaction, and costs were tracked.
Main Results:
- Patient volumes increased by 42.0% and 32.7% in September and October 2009, respectively.
- 612 patients were triaged to ILI Extension Areas, with LOS comparable to previous years.
- LWBS rates were slightly elevated but remained manageable, and patient satisfaction scores were consistent throughout the year. Financial performance was favorable.
Conclusions:
- The tiered surge response plan successfully managed high volumes of low-acuity patients during an extended surge period.
- This model provides an effective framework for future patient surge management in emergency departments.
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.
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