Patient flow key to managing H1N1 influx

At Cincinnati Children’s, the month of October is being affectionately referred to as “baptism of fire.” H1N1 hit our emergency departments hard — nearly 800 patients in one day at the two EDs combined (normal numbers are 350-400). But the experience has proven what’s possible with organization and preparation.

We started planning for the onslaught of flu patients back in the spring when the first H1N1 reports came out of Mexico.

H1N1 virus under a microscope

Because we knew the flu was coming, we had time to do some strategic planning up front. This is a luxury we don’t normally have, but were grateful for the opportunity to dot “I’s” and cross “T’s” this time.

As the numbers have subsided and reports from the CDC indicate we’ve probably seen the worst of H1N1, we’re taking a few minutes to reflect.

While we knew most of the patients would arrive through the ED, hospital leadership recognized immediately that H1N1 would be an institution-wide problem, not just an ED problem.

After considerable shuffling among existing clinics, we found a dedicated space at both the main campus and Liberty Township. There we set up overflow clinics to handle the additional patient load.

The process for moving these patients through the clinic quickly and efficiently was created from the ground up. The Advanced Practice Nurses worked with the ED staff to create orientation materials and post them on our intranet, where physicians could easily access them prior to a shift in the overflow clinic. The team designed triage criteria to allow the sickest kids to go to the ED, while lower acuity patients were routed to the clinics.

Documentation and billing were streamlined and handled completely on paper – we didn’t have time to train everyone on software programs they’d never used before.

The nursing staff provided consistency in the clinics for physicians who weren’t used to practicing in primary care environments.

Departments all over the medical center did their part to make this happen: the Medical Staff office expedited signing of practice agreements and billing enrollment for nurse practitioners; Materials Management made sure there was enough personal protective equipment to keep everyone safe; Occupational Safety and Environmental Health did fit testing of masks and respirators; Employee Health administered vaccine as and when it became available; Pharmacy maintained an adequate supply of antiviral medication; and Protective Services helped Welcome Center staff implement visitor restrictions.

At the end of the day, only two things really surprised us – the rapidity in which we saw the sudden spike in patients and the explosion of patient volume at the suburban (Liberty) ED.

H1N1 pushed a lot of people to think outside the box. Long-timers are saying they’ve never seen anything like what we experienced here in October.

We believe it was a once-in-a-lifetime surge, but we know that preparation and knowledge acquired through our everyday focus on patient flow paid off this time and will again, should we encounter another such situation.

Our chief of staff recently commented, “the remarkable thing to me is that we cared for all these patients, and we didn’t have to cancel anything – not clinics, not elective surgeries.”

We’re watching CDC reports closely, as are so many others, I’m sure.