Waseem Muhammad, McInerney Joan E, Perales Orlando, Leber Mark
Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, NY 10451, USA.
Pediatr Emerg Care. 2012 Jan;28(1):39-42. doi: 10.1097/PEC.0b013e31823f23fb.
A level 1 pediatric emergency department (ED) in a public hospital of South Bronx rapidly encountered a significant surge in ED patient census over several days as the novel H1N1 influenza outbreak occurred. Our aim was to identify ill patients with influenza-like illness and evaluate and treat them as expeditiously as possible without failing in our responsibility to treat all patients. We describe the ED response to the outbreak during 2009 H1N1-related visits.
The objective of this study was to describe and compare pediatric ED visits during the fall 2009 H1N1 to that in the previous year.
The department reorganized patient flow in the ED to maximize the understanding of where to best apportion our resources and to minimize walkout and return visit rates. We developed staging of the flow of patients. This included, but was not limited to, a rapid screening at pretriage stage, early registration before the formal triage, and expanding the service. We compared walkout rates during fall 2009 and fall 2008. Return visits for asthmatic patients within 7 days were also compared.
Over a period of 48 days, 8841 patients visited the pediatric ED. The average number of visits during this outbreak was 184 per day (usual visits per day, 80-110). Overall ED visits increased by 93.6% (95% confidence interval [CI], 78.2%-109.6%; P < 0.001). Fifty-two patients tested positive for H1N1. The walkout rate was 2.9% (95% CI, 1.9%-4.0%) in 2009 compared with the walkout rate of 1.5% (95% CI, 1.0%-2.0%) in 2008. There were no statistically significant differences between walkouts (P = 0.06) and 7-day asthma revisits (P = 0.07) in 2008 and 2009 despite the almost doubling of the ED visits. Admission rates from 2009 did not significantly differ from 2008 (11.2% [990/8841] vs 10.2% [464/4560], P = 0.07).
Staging of a surge volume allows ED administrators to maintain a strong control of a multipatient event to ensure an effective response and appropriate use of limited resources. The implementation of the reorganized measures during the fall 2009 H1N1-related surge in patient's visits resulted in improved patient flow without significant increase in walkout and 7-day asthma revisit rates. Our strategies accommodated the surge of patients in the ED.
随着新型H1N1流感疫情的爆发，南布朗克斯区一家公立医院的一级儿科急诊科在数天内迅速迎来了急诊患者人数的显著激增。我们的目标是识别患有流感样疾病的患者，并尽快对他们进行评估和治疗，同时不辜负我们治疗所有患者的责任。我们描述了急诊科在2009年H1N1相关就诊期间对疫情的应对措施。
本研究的目的是描述和比较2009年秋季H1N1疫情期间与上一年儿科急诊科的就诊情况。
该科室重新组织了急诊科的患者流程，以最大程度地了解如何最佳分配我们的资源，并尽量减少患者自行离开和复诊率。我们制定了患者流程的阶段划分。这包括但不限于在预检阶段进行快速筛查、在正式分诊前进行早期登记以及扩大服务。我们比较了2009年秋季和2008年秋季的患者自行离开率。还比较了哮喘患者7天内的复诊情况。
在48天的时间里，8841名患者前往儿科急诊科就诊。此次疫情期间的平均每日就诊人数为184人（平日每日就诊人数为80 - 110人）。急诊就诊总数增加了93.6%（95%置信区间[CI]，78.2% - 109.6%；P < 0.001）。52名患者H1N1检测呈阳性。2009年的患者自行离开率为2.9%（95% CI，1.9% - 4.0%），而2008年的自行离开率为1.5%（95% CI，1.0% - 2.0%）。尽管急诊就诊人数几乎翻倍，但2008年和2009年患者自行离开率（P = 0.0
