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Going viral: adapting to pediatric surge during the H1N1 pandemic
Sarita Chung1, Daniel Fagbuyi, Marie M Lozon
1From the *Division of Emergency Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA; †Division of Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine, Washington, DC; ‡Children's Emergency Services, University of Michigan Health System, Ann Arbor, MI; §Department of Pediatrics, Division of Emergency Medicine, Department of Medicine, Division of General Internal Medicine University of Pittsburgh, Pittsburgh, PA; ∥Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA; ¶Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT; #Division of Pediatric Emergency Medicine, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland OH; **Pediatrics and Emergency Medicine at Emory University School of Medicine, Atlanta, GA; ††Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
Insights
Many hospitals lacked pandemic plans before the 2009 H1N1 influenza pandemic and had to adapt surge strategies. Compliance with CDC guidelines for pediatric patient care varied, highlighting a need for improved preparedness.
Area of Science:
- Public Health
- Epidemiology
- Emergency Medicine
Background:
- The 2009 H1N1 influenza pandemic strained healthcare systems, particularly pediatric emergency departments.
- Assessing preparedness and response strategies is crucial for optimizing surge capacity.
Purpose of the Study:
- To evaluate hospital and emergency department (ED) pediatric surge strategies during the 2009 H1N1 pandemic.
- To determine compliance with national Centers for Disease Control and Prevention (CDC) guidelines.
Main Methods:
- An electronic survey was distributed to emergency physicians and nurses in US EDs with high pediatric volumes.
- The survey assessed pandemic preparedness, surge strategies, and adherence to CDC guidelines for personal protection, testing, and treatment.
Main Results:
- 44% of hospitals lacked preexisting influenza pandemic plans; 91% developed them during the pandemic.
- Significant plan modifications occurred for ED staffing (82%) and alternate care sites (68%).
- Initial CDC guideline compliance for personal protection (N95 masks) was 79%, but practices were later revised; compliance for patient testing (60%) and treatment (68%) was incomplete.
Conclusions:
- Over 40% of surveyed hospitals were unprepared with an influenza pandemic plan prior to H1N1.
- Many institutions modified existing plans during the surge, indicating a reactive rather than proactive approach.
- Inconsistent adherence to CDC guidelines underscores the need for enhanced pediatric surge planning and preparedness.
Objectives:
The objective of this study was to assess hospital and emergency department (ED) pediatric surge strategies utilized during the 2009 H1N1 influenza pandemic as well as compliance with national guidelines.
Methods:
Electronic survey was sent to a convenience sample of emergency physicians and nurses from US EDs with a pediatric volume of more than 10,000 annually. Survey questions assessed the participant's hospital baseline pandemic and surge preparedness, as well as strategies for ED surge and compliance with Centers for Disease Control and Prevention (CDC) guidelines for health care personal protection, patient testing, and treatment.
Results:
The response rate was 54% (53/99). Preexisting pandemic influenza plans were absent in 44% of hospitals; however, 91% developed an influenza plan as a result of the pandemic. Twenty-four percent reported having a preexisting ED pandemic staffing model, and 36% had a preexisting alternate care site plan. Creation and/or modifications of existing plans for ED pandemic staffing (82%) and alternate care site plan (68%) were reported. Seventy-nine percent of institutions initially followed CDC guidelines for personal protection (use of N95 masks), of which 82% later revised their practices. Complete compliance with CDC guidelines was 60% for patient testing and 68% for patient treatment.
Conclusions:
Before the H1N1 pandemic, greater than 40% of the hospitals in our study did not have an influenza pandemic preparedness plan. Many had to modify their existing plans during the surge. Not all institutions fully complied with CDC guidelines. Data from this multicenter survey should assist clinical leaders to create more robust surge plans for children.
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