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Plenty has been written and said about the H1N1 flu virus: don’t panic, it’s treated the same as seasonal flu, wash your hands, cough into your arm, stay home if you’re sick. What’s seldom discussed is the impact of the so-called swine flu on besieged healthcare workers and facilities.
Despite the best intentions, many hospitals have been caught flatfooted. A finite number of doctors, nurses and space set against an escalating number of patients is, quite simply, a problem – a problem for which ETMC Athens was prepared.
“We were ready,” said Dr. Dan Bywaters, the medical director of the hospital’s emergency department. “We put together a surge plan before it hit.”
A surge plan is a pre-existing guideline on how to handle a sudden and dramatic increase in the number of patients. That dramatic increase is precisely what happened at ETMC Athens.
In early September, the number of patients per day coming into the ER averaged 82. By the end of September, that number had jumped to 116. That’s a 42-percent increase within a few weeks’ time. As of this writing, the average number of ER patients per day has dropped slightly, to 100. But that’s still well above the pre-flu season norm.
“As far as we can tell, this hospital has never experienced this sustained 100-plus volume through the emergency department,” said Brit Watts, a clinical consultant with Compirion Healthcare Solutions.
It was the foresight of ETMC Athens Administrator Pat Wallace which brought in a team of consultants this past April from Compirion, a healthcare consulting firm focusing on improving hospital performance.
“We know, for the time being, we’re limited in terms of the space available in the ER,” said Wallace. “But we aren’t limited in terms of streamlining the process of moving people through the emergency department as efficiently as possible. We knew we could do better, and we’ve done so.”
This past April, the team from Compirion began working hand-in-hand with existing staff under the leadership of Bywaters and Emergency Department Director David Williams.
One of the first decisions made was to improve the way patients move through the emergency department. As patient movement became more efficient, physician hour coverage was increased, and a special area was dedicated to see less acute patients, including those with flu-like symptoms. These changes were made in August and September.
“Those changes significantly reduced the amount of time patients spent in the ER and helped the hospital handle the surge in patient volume,” said Wallace.
“It’s a credit to this hospital and its people that we put an effective surge plan together in relatively short order,” said Bill Scarnato, SVP of Operations for Compirion. “When you talk about a 42-percent increase inside 30 days – where would we be today if we hadn’t put that plan together?”
Patient vists and patient stays
Remarkably, though the average number of daily patients has skyrocketed, the average length of visit for those patients has dropped by just over an hour. In early 2009, the average length of visit was 233 minutes. As of this writing, it’s 165 minutes (2 hours and 45 minutes) and improving.
How has that been possible? Thanks to two main components: the creation of a temporary triage treatment area which converted existing non-patient space into five treatment spots, and an overhaul of the process by which patients are seen through an ER visit.
Technically, the emergency department has 15 rooms. When needed, four hallway beds are also utilized. In addition to that, as part of the surge plan, are the five treatment areas in triage (just off the waiting area) designated to handle patients with flu and flu-like symptoms. A physician and nurse staff the triage treatment area during peak hours.
The triage treatment area is not intended as a permanent fixture. When the impact from the flu lessens, those areas will no longer be used for treatment.
“The sustainable part of what we’ve done, what will not be changing, is the new process developed by the existing team here in the emergency department,” explained Watts.
“The commitment to overhauling the process has been outstanding,” agreed Scarnato. “What we’ve experienced is that the medical and nursing staff has been very committed to improving the way things are done. They’ve bought into the change, and that’s what’s made it successful.”
That success couldn’t come at a more critical time. While the impact of flu patients has slackened somewhat of late, healthcare workers are being warned of another surge in H1N1 patients. And, Dr. Bywaters pointed out, “We haven’t even seen regular seasonal flu hit yet.”
So get vaccinated, wash your hands and wait for this season to pass.
Read our previous report about H1N1 preparation at ETMC Athens