221662 Managing novel influenza A (H1N1) outbreak-related ambulatory pediatric patient surge: A health system perspective

Wednesday, November 10, 2010 : 8:45 AM - 9:00 AM

Jane Greenko, EMT-P, MPH, CIC , Epidemiology/Infectious Disease Service, North Shore University Hospital, Manhasset, NY
Donna Armellino, RN, DNP, CIC , Epidemiology/Infectious Disease Service, North Shore University Hospital, Manhasset, NY
Mary Mahoney, RN, BSN , Emergency Management, North Shore LIJ Health System, Syosset, NY
Mary Ann Haran, RN, BSN , Epidemiology/Infectious Disease Service, Long Island Jewish Medical Center, New Hyde Park, NY
Susan Nullet, RN, MS , Epidemiology/Infectious Disease Service, Long Island Jewish Medical Center, New Hyde Park, NY
Christine C. Ginocchio, PhD , Department of Pathology and Laboratory Medicine, North Shore-LIJ Health System Core Laboratories, Lake Success, NY
Joy Nagelberg, MD , Department of Pediatric Emergency Medicine, North Shore-LIJ Schneider Children's Hospital, New Hyde Park, NY
Salvatore Pardo, MD, FACEP , Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, NY
Lorry Rubin, MD , Department of Pediatric Infectious Diseases, North Shore-LIJ Schneider Children's Hospital, New Hyde Park, NY
Barbara T. Edwards, MD , Infectious Diseases, Long Island Jewish Medical Center, New Hyde Park, NY
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.

Learning Areas:
Epidemiology
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public

Learning Objectives:
Describe the epidemiology of ambulatory pediatric ED patients related to the novel influenza A (H1N1) outbreak Describe a health systems experience managing ambulatory pediatric ED patient surge during peak of novel influenza A (H1N1) outbreak Understand challenges of managing public health emergency-related ambulatory pediatric patient surge in primary receiving hospitals. Identify opportunities to enhance risk messaging to target populations in health system catchment areas.

Keywords: Infectious Diseases, Risk Communication

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I manage the infection control program at my institution and have obtained certification in infection control (CIC)
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5041.0: Epidemiology of influenza