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Pandemic Influenza Triage in the Clinical Setting

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Title: Pandemic Influenza Triage in the Clinical Setting


1
Pandemic Influenza Triage in the Clinical Setting
  • Steven J. Rottman, Kimberley I. Shoaf,
  • Jennifer Schlesinger, Eva Klein Selski,
  • Joey Perman, Kerry Lamb, and Janet Cheng

2
Are Clinical Practitioners Thinking About Pan Flu?
  • Since hospital emergency departments will be a
    point of impact for those seeking care
  • Are staff aware of the potential for pandemic?
  • What are the implications in the emergency
    setting?
  • Is there guidance for the clinical management of
    large numbers of variably ill patients?

3
Background Types of Influenza
  • Seasonal flu
  • Avian flu
  • Pandemic flu

4
H5N1 Avian Influenza
  • 2007
  • Human-to-human transmission
  • Bird Outbreaks
  • 2008
  • 373 Human cases
  • 63 Case Fatality
  • 14 Countries affected

5
20th Century Pandemics
6
Pandemic Influenza Today?
  • In the United States
  • 1.9 million people could die
  • 9.9 million could be hospitalized
  • 90 million could become ill
  • Intense pressure on healthcare
  • Disruption to many aspects of daily life

7
Federal Recognition
8
Steps Taken Since 2000
  • August 26, 2004 HHS Issues National Pandemic
    Influenza Preparedness Plan
  • November 2005 National Strategy to Safeguard
    Against Pandemic Influenza
  • 2006-2007 400 million to all States for Pan Flu
    Planning
  • March 2006 Hospital Pandemic Influenza
    Guidelines for Acute Care Hospital Settings LA
    County Dept Public Health
  • September 12, 2007 Hospital Pandemic Influenza
    Planning Checklist HHS

9
Methods
  • Key Informant Interviews
  • IRB approval and participant consent forms
  • Recorded
  • Transcribed
  • Coded for themes

10
Open-Ended Prompts
  • Four general themes
  • Supplies/Resources of the institution
  • Triage parameters within the institution
  • Quality of Care
  • Authority for Institutional Decisions

11
The Sample
  • Convenience Sample
  • ED Nurse (7)
  • ED Physician (11)
  • Infection control (9)
  • Nursing Supervisor (9)
  • Hospital Administrator (10)

12
FindingsStatus Quo
  • Its just another bad day
  • I dont really feel we would do anything
    different for any kind of disaster, either flu or
    bioterrorism. (Inf. Control)
  • Whether our patients are urgent or non-urgent,
    they all get the same type of care. (ED MD)
  • I dont know what lower quality of care would
    mean. I dont think it will be my concern. (RN
    Sup)

13
Recognition of the Problem
  • The biggest concern is the emotional wear and
    tear on the staffwe think we can do the best for
    everybody. Sometimes we just cant. (ED RN)
  • you cant save everybody. You are going to
    have to use your resources for those that can be
    saved. (RN Sup)
  • I dont think we have that kind of experience I
    dont think we have the training to understand
    what decisions might need to be made. (ED MD)

14
Quality of Care
  • Stratification of the quality of care
  • Decreased staffing/resources recognized but not
    connected to reduced standards of medical care
  • Ethical Concerns

15
Triage
  • Logistical Concerns
  • Triage Site
  • Lack of Staff
  • Infection Control
  • Patient Surge
  • Chaos/crowd control

16
Institutional Needs
  • Logistical and Macro-level
  • Staffing
  • Resources
  • Training
  • Operational Guidelines
  • Triage, MD Licensing, Liability

17
The Public
  • Need for public education
  • Symptoms
  • Social Distancing
  • Public reactions/behavior
  • Worried well
  • Vulnerable populations

18
Need for Public Health Action
  • I think we need that expert voice in Public
    Health. We dont need it at the time we need
    it now. (RN Sup)
  • There needs to be some coordinated effort,
    increased awareness, and some guidance for
    preparedness. (Adm)
  • The Dept of Health is some mysterious agency
    that Ive never seen. Ive never heard from
    them. We dont know who they are. (ED MD)

19
Conclusion
  • Qualitative assessment
  • Los Angeles specific
  • Different kinds of institutions and staff roles
    provided a glimpse of common themes
  • Preparation and planning must continue

20
Inspirational Quotes
Is there really going to be a pandemic flu? Is
it going to be in our life time? (RN Sup)At
least from what Ive been able to read, its
possible we could be overwhelmed. (Adm) God
help us all if it really happens. (Adm)
21
References
  • PandemicFlu.gov
  • US Dept of Health Human Services. HHS Pandemic
    Influenza Plan. http//www.hhs.gov/pandemicflu/pla
    n/part1.html
  • Center for Disease Control PreventionInterim
    Pre-Pandemic Planning Guidance Community
    Strategy for Pandemic Influenza Migration in the
    United States
  • Southern California Summit on Cross-Sector
    Pandemic Influenza Planning. California
    Department of Public Health.
  • Bartlett, JG. Planning for Avian Influenza.
    Annals of Internal Medicine. 2006 145. p.141-144

22
  • Thank you!
  • Joey Perman
  • jperman_at_ucla.edu
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