Managing novel influenza A (H1N1) outbreak-related ambulatory pediatric patient surge: A health system perspective

Background: On April 24, 2009, students from a New York City (NYC) school presented with influenza-like illness (ILI) to a hospital emergency department (ED) of Schneider Children's Hospital at Long Island Jewish Medical Center (LIJMC). These were the initial cases of novel influenza A (H1N1) infection in NYC. Despite public health risk messaging LIJMC experienced a surge of ambulatory pediatric ED patients with influenza-related complaints during this outbreak and subsequent pandemic. Methods: Demographic, clinical, and laboratory data were collected for all LIJMC ED visits for influenza-related complaints using standardized tools. ED logs and public health surveillance definitions were used to identify cases. Descriptive epidemiologic analysis was conducted to drive the LIJMC response and characterize the first 6 weeks of the novel influenza A (H1N1) outbreak. Results: LIJMC received over 3200 ED visits for influenza-related complaints 4/24/09-5/31/09. Pediatric patients accounted for 74% of all influenza-related ED visits. Alternate ED triage sites were mobilized during waves of peak ambulatory pediatric patient volume. Patients reported use of personal technology and social networking to influence friends to seek evaluation at LIJMC ED despite public health risk messaging. Post-event gap analysis was conducted. Conclusions: Health system-level pediatric emergency preparedness improves management of individual needs as well as the community response as a whole. LIJMC preparedness efforts allowed for successful management of novel influenza A (H1N1)-related ambulatory pediatric ED patient surge during the spring 2009 outbreak. Risk messaging to vulnerable populations in the NSLIJHS catchment area should include alternative methods such as social networking.