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Admission Control

February 24, 2010
by Kate Huvane Gamble
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When H1N1 hit, Children's Healthcare of Atlanta answered back with a multi-pronged plan designed to educate patients and keep staff informed
Praveen chopra
Praveen Chopra

In 2009, hospitals all over the United States were affected by an outbreak of the swine influenza A (H1N1), virus - some more severely than others. One of the first areas of the country affected was the Southeast; with Florida and Georgia at the forefront. When the World Health Organization declared the severity of the influenza as a global pandemic, healthcare providers were forced to deal with not just the virus itself, but the misinformation and fear that prompted hundreds of patients to crowd emergency departments seeking tests and medications.

“We were seeing a high degree of false alarms,” says Praveen Chopra, vice president and CIO at Children's Healthcare of Atlanta, a three-hospital, 510-bed organization. “People were coming in because they had heard about H1N1, and they were bringing their children to our ED.”

Breaking Down “Operation Prevent Flu”

When concerns about the H1N1 virus prompted fear among patients and led to overcrowding in the emergency departments, Children's Healthcare of Atlanta took action. Despite having just a small window of time, the Pandemic Task Force was able to devise a plan to help educate patients and prepare staff to deal with the outbreak by completing the following tasks:

  • Create “Operation Prevent Flu” hub on the Children's intranet site with updates, links and resources for staff

  • Create influenza planning dashboard providing daily metrics of patient volumes by location and chief compliant, ED turnaround times and admissions

  • Develop H1N1 hotline email address for physicians and employees

  • Update order sets to quickly revise flu-testing orders

  • Use monthly and weekly clinical manager memos to disseminate information, answer questions and recruit backup staffing

  • Establish flu clinics using an electronic staffing system

  • Create flu Web site for patient families containing information, teaching sheets and an interactive protocol to determine need for medical intervention

  • Host interactive Webinars for physicians and staff

  • Partner with local media to host online QandA sessions, press conferences and community blogs

  • Utilize school listserv to disseminate flu-testing information to school administrators

Daniel salinas
Daniel Salinas

Daniel Salinas, M.D., senior vice president and chief medical officer at Children's, says, “One of the things we found out early was that there was a lot of misconception and misinformation. So we decided we had to stand up as the experts and do what we can to make sure we take care of the kids and also allay some of the families' fears.”

Wasting no time, Children's developed a plan to educate patients and staff about H1N1, using technology and resources it already had. The result was Operation Prevent Flu, a multidisciplinary initiative that was so successful it became a model for other health organizations.

Jim fortenberry
Jim Fortenberry

At the core of the effort, which involved more than 100 staff members, were two primary goals: to increase responsiveness and efficiency among the staff, and to more effectively manage the volume of patients in the ED (See the sidebar for more information about the project). “In the overwhelming majority of children, the H1N1 virus only caused a mild to moderate flu-like illness,” says Jim Fortenberry, M.D., who serves as pediatrician-in-chief at Children's Healthcare of Atlanta, and medical director, Division of Critical Care Medicine, at the Egleston campus. “So what we were trying to do was to help educate, reassure and guide families, and also help provide resources for community physicians on what needed to be done. Our focus was on how we can control patients getting into the ED in the first place.”

Getting the word out

One of the first steps was to develop a triage system - accessible by phone or Internet - in which patient families answer a series of questions to determine whether an ED visit is necessary. The Information Systems and Technology (ISandT) department partnered with physicians as well as the Call Center staff to develop an evidence-based algorithm and post it to the organization's Internet site. “We took the knowledge we had and transferred it into a question-and-answer toolset that would act as a decision tree for families,” says Chopra.

The protocol proved successful, according to Renee Watson, manager of infection control at Children's. During Labor Day weekend, when the second wave of H1N1 was at its height, 80 percent of patients who used the algorithm were instructed to stay at home and take over-the-counter medications - and the large majority of them did just that, she says. “If all or even some of those patients had presented to the hospital, it would've further disabled our system.”

What was critical, says Salinas, wasn't just that Children's had a site offering patients assistance, but that it was up and running within a short time period. “Our ISandT team really stepped up to the table for us. They had other projects, but they put them to the side to focus on this.”