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H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia
The document outlines a study on the response of an influenza assessment clinic (IAC) and its collaboration with an emergency department (ED) during the 2009 H1N1 pandemic in Australia. It reports a significant increase in patient presentations, necessitating changes in ED strategies and highlights the demographic characteristics of patients presenting with influenza-like symptoms. The study suggests the need for sustainable models to manage influenza outbreaks effectively rather than reactive measures during pandemics.
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H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia
- 1. H1N1 Influenza 2009:A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in AustraliaJamie RanseLecturerDisciplines of Nursing and MidwiferyFaculty of Health University of CanberraPhone: +61 (0)2 6201 5380Fax: +61 (0)2 6201 5128Email: jamie.ranse@canberra.edu.au Blog: www.jamieranse.comTwitter: jamieranse
- 2. research teamMr JamieRanse1,2Mr Shane Lenson3Mr Matthew Luther4Dr Lily Xiao11. University of Canberra2. Flinders University3. Royal College of Nursing, Australia 4. Calvary Health Care ACTResearch GrantACT Health: Practice Development Grant
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- 4. backgroundIn June 2009the WHO elevated their pandemic index to Phase 6.Worldwide as at February 2010:213 countries16,455 deathsAustralia as at February 2010:37,700+ cases13% hospitalised (M = 31 yrs)14% of these required ICU (M= 40yrs)191 deaths (M=48 yrs)
- 5. background: emergency departments30%increase in patient presentationsChange in functionStrategiesSeparate triage areasSurge clinicsInfluenza Assessment Clinic (IAC)
- 6. background: influenza assessmentclinicOpened based on ED demand / trigger pointsFirst day clinic on 26th May 2009Monday – Friday; 0900 – 1700Surge outside business hoursCollocated
- 7. aimThis study describedthe profile of patients presenting to the IAC and ED with influenza-like symptoms, and tested the relationships that influenced the collaboration between the IAC and ED.
- 8. methodDesignThis study wasretrospective in nature, utilising a descriptive study designSettingCalvary Hospital is a 334 bed community hospital in the city of Canberra, in the Australian Capital TerritoryThe public ED has approximately 45,000 presentations per annumCanberra is an inland city of approximately 350,000 people
- 9. methodSample and populationNon-probability purposive sampling All patients that presented to the Calvary Hospital IAC and ED during the period of 3 June 2009 to 3 July 2009Sample included all presentations from the above population that presented with influenza-like symptoms, and included a total of 1106 persons
- 10. method: data collectionDatacollectionRetrospectively from an existing ED patient information systemIAC utilised an existing ED patient information systemAn independent identifying code, as a data collection and patient tracking tool. Date, time, complaint, disposition and demographic information.
- 11. methodData analysisDemographic characteristicsfor Descriptive statisticst-test for interval dataMann-Whitney U test for ordinal dataChi-square test for nominal dataProtection of human participantsApproved by a human research ethics committee
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- 20. discussionIncrease in patientpresentations on average of 36 per day; similar to the Victorian experience of a 30% increase Patients presented in the AMResearch should explore factors that influence patient presentation timesIAC on a surge basis
- 21. discussionPatients who presentedto the ED were younger (M=23) than the IAC (M=30)Few of the patients that presented were over the age of 65 (N=24/1106; 2.2%)Need to report nationally (ILS)
- 22. discussionA sustainable IAClike model needs to existTest models during seasonal influenza periods, rather than a reactive composition during a pandemic response.Prospective data collection
- 23. limitationsA single AustralianIAC and EDResults may differ in differing influenza strains Did not provide epidemiological information about the attack rate of confirmed H1N1 2009
- 24. moreinformation? Australasian Emergency NursingJournalAustralian Journal of Emergency Management
- 25. H1N1 Influenza 2009:A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in AustraliaJamie RanseLecturerDisciplines of Nursing and MidwiferyFaculty of Health University of CanberraPhone: +61 (0)2 6201 5380Fax: +61 (0)2 6201 5128Email: jamie.ranse@canberra.edu.au Blog: www.jamieranse.comTwitter: jamieranse
Editor's Notes
- #5 In June 2009 the World Health Organisation (WHO) elevated their pandemic index to Phase 6, indicating human-to-human transmission had occurred at a community level across multiple countries and WHO regions. This index relates to incidence of disease rather than morbidity or mortality severity.As of February 2010, over 213 countries and overseas territories or communities had laboratory confirmed cases of H1N1 2009 influenza, and an estimated 16,455 deaths had occurred worldwide.In Australia, there have been over 37,700 laboratory confirmed cases of H1N1 2009 influenza, with 13% (4,992/37,713) requiring hospitalisation, and 14% of these (681/4,992) requiring intensive care management.
- #6 There was a reported 30% increase in patient presentations to EDs in Victoria in June 2009.This increase in patient presentations resulted in some changes in function within these EDs. This type of change was seen throughout the world with many health facilities and health services implementing strategies to prevent the ongoing transmission of H1N1 2009 influenza. Within the ED, strategies primarily focused on diverting patients with influenza-like symptoms from the general ED patient population to specific streams of care. Such strategies outlined to date in the literature include having a separate triage area,6 establishing surge clinics during busy periods,7 and establishing IACs.5,8
- #7 Many health facilities and health services in Australia established IACs as a strategy to divert high volumes of low acuity patients away from the EDs.5 These IACs were then closed once community demand diminished. Calvary Health Care ACT (Calvary Hospital) established an IAC which operated from 03 June 2009, with sustained operations, Monday to Friday, 0900 – 1700, until 03 July 2009. The IAC was collocated with the ED on the hospital campus; however, it was segregated from the ED and isolated from the general hospital as part of the hospital pandemic infection control management plan. Collocating the IAC and ED was a strategy that enhanced the institutions response capacity.9 The IAC was staffed by nurses from the ED and General Practitioners from the community. Details of this IAC establishment have been outlined by Luther and Lenson,8 who provide an overview in the rapid establishment of an IAC.
- #8 Therefore, this study aims to: Describe the frequency and demographic characteristics of patients presenting with influenza-like symptoms to the Calvary Hospital IAC and ED during the H1N1 2009 influenza pandemic, Identify the ratio of admissions to discharges in persons presenting with influenza-like symptoms, and Analyse the caseload as shared by the IAC and the ED.
- #10 This period was chosen as it was the period in which the IAC was initially established and operational using nurses from the ED to sustain services. The sample included all presentations from the above population that presented with influenza-like symptoms, and included a total of 1106 persons.