224370 Resource burden at children's hospitals during the spring 2009 H1N1 pandemic

Tuesday, November 9, 2010

Marion Sills, MD, MPH , Department of Pediatrics, Division of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
Matthew Hall, PhD , Research Department, Child Health Corporation of America, Shawnee Mission, KS
Nicholas Walter, MD, MS , Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO
Evan Fieldston, MD, MBA, MSHP , Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania School of Medicine, Philadelphia, PA
Harold K. Simon, MD, MBA , Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, GA
Heather Anderson, PhD , Colorado School of Public Health, Aurora, CO
William Padula, MS , Pharmaceutical Outcomes Research Program, University of Colorado School of Pharmacy, Aurora, CO
Anne Libby, PhD , School of Pharmacy, University of Colorado Denver, Aurora, CO
Michael Mundorff, MBA, MHSA , Primary Children's Medical Center, Intermountain Healthcare, Salt Lake City, UT
Thomas Brogan, MD , Department of Critical Care, Seattle Children's Hospital, Seattle, WA
Denise Goodman, MD , Department of Pediatrics, Division of Critical Care, Northwestern University's Feinberg School of Medicine, Chicago, IL
James Levin, MD, PhD , Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
Daniel Fagbuyi, MD , Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC
Beth Schissel, MD , Department of Pediatrics, Division of Emergency Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO
Anthony Slonim, MD, DrPH , Departments of Medicine and Pediatrics, Carilion Medical Center, Roanoke, VA
D.D. Fritch-Levens, RN , Emergency Department, Children's Healthcare of Atlanta, Atlanta, GA
Paul Hain, MD , Department of Pediatrics, Division of Hospital Medicine, Vanderbilt University School of Medicine, Nashville, TN
Samir Shah, MD, MSCE , Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA
Objective: Describe the ED utilization burden of the April- July 2009 H1N1 influenza pandemic at tertiary care children's hospitals in the US by quantifying observed utilization as a proportion of expected utilization. Methods: We used the Pediatric Health Information System database of emergency department (ED) visits for 23 children's hospitals, using data from April-July 2009, with data from the corresponding weeks of 2004-08 as comparison. Observed weekly ED visits for influenza-like illness (ILI) were calculated using previously-validated ICD-9 codes for ILI. A time series was fit to the 2004-08 data to generate expected weekly values for 2009. The start and end of each ED's surge period was defined by the first and last 2 adjacent weeks with observed ED ILI visits above the upper 95% confidence limit for the expected value. For each ED, we report the surge duration, and the observed:expected ratio for ED visits, ED ILI visits, necessary ED visits, admissions, deaths, and influenza-related tests, medications, and procedures. Results: Of the 23 EDs, 13 experienced a surge in ED ILI visits. The median surge duration was 2 weeks, with an interquartile range (IQR) of (0, 5). The median (IQR) observed:expected ratio for ED ILI visits was 1.42 (1.32, 1.61). The median (IQR) observed:expected ratio for the peak week was 1.88 (1.52, 2.11). Conclusions: The Spring 2009 H1N1 influenza surge was experienced by most children's hospital EDs. Surge magnitude and duration varied, but, at its peak, the EDs experienced a median ED ILI visit rate of 88% above expected utilization.

Learning Areas:
Administration, management, leadership
Clinical medicine applied in public health
Epidemiology
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related research

Learning Objectives:
Describe the ED utilization burden of the April- July 2009 H1N1 influenza pandemic at tertiary care children’s hospitals in the US by quantifying observed utilization as a proportion of projected utilization.

Keywords: Emergency Department/Room, Health Care Utilization

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a pediatric emergency medicine clinician at one of the hospitals described and I help to lead a research group devoted to this topic at the Child Health Corporation of America.
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.