Hospital

PandemicInfluenzaPlanning

by Ed Lydon, CVPH

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Understand how your hospital is prepared

Understand the standard of care as we know it today will change

Understand your participation in the care of family members is critical to survival

We can expect during the peak of a pandemic that hospital emergency departments, in-patient care units and outpatient offices will be overwhelmed with patients seeking care.

The public will need to know what they can do to prevent disease transmission in the hospital, as well as at home and in community.

The health care infrastructure will need to have an efficient means of managing influenza cases.

This will reduce progression to severe disease and thereby reduce demand for limited inpatient resources.

We need to minimize the burden on physicians and to reduce exposure of the “worried well” to persons with influenza, telephone hotlines will need to be established to provide advice on whether to stay home or to seek care.

We need to identify a “trigger” point at which screening for signs and symptoms of pandemic influenza in all persons entering the hospital will escalate from passive (e.g., signs at the entrance) to active (e.g., direct questioning).

We will define “essential” and “non-essential” visitors with regard to the hospital and develop protocols for limiting non-essential visitors.

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We will need to involve hospital security services in enforcing access controls and if available augment those services with local law enforcement officials.

We need to develop a strategy for triage, diagnosis, and isolation of possible influenza patients. We need to consider the following triage mechanisms: Using phone triage to identify patients

who need emergency care and those who can be referred to a medical office or other non-urgent facility

Assign separate waiting areas for persons with respiratory symptoms

Assign a separate triage evaluation area for persons with respiratory symptoms

Assign a “triage coordinator” to manage patient flow, including deferring or referring patients to alternative care facilities.

We will need to address how essential medical services will be maintained for persons with chronic medical problems served by the hospital (e.g., hemodialysis patients).

And develop a strategy for ensuring uninterrupted provision of medicines to patients who might not be able to (or should not) travel to pharmacies.

We need to promote annual influenza vaccination among hospital staff and community.

Increased influenza vaccination coverage may help increase vaccine acceptance during a pandemic and will limit the spread of seasonal influenza.

We will establish a strategy for rapidly vaccinating or providing antiviral prophylaxis to healthcare personnel as they are part of the critical infrastructure.

We may need to develop a stratification scheme for prioritizing vaccination of healthcare personnel who are most critical for patient care and essential personnel to maintain the day-to-day operation of the healthcare facility.

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Will need to provide psychosocial support services that help workers manage emotional stress during a response to an influenza pandemic including personal, professional and family issues.

We will cross-train clinical personnel, including outpatient healthcare providers, who can provide support for essential patient-care areas (e.g., emergency department, ICU, medical units)

A strategy will be developed for “just-in-time” training of non-clinical staff who might be asked to assist clinical personnel (e.g., help with triage, distribute food trays, transport patients), students, retired health professionals, family and volunteers may be asked to provide basic nursing care (e.g., bathing, monitoring of vital signs)

We need to be sure that our existing systems for tracking available medical supplies in the hospital can report rapid consumption, including items that provide personal protection (e.g., gloves, masks)

We have begun stockpiling consumable resources such as pharmaceuticals and personnel protective equipment for an estimated duration of a pandemic wave (6-8 weeks).

We continue to assess anticipated needs for consumable and durable resources, and determine a trigger point for ordering extra resources.

We need to estimate the need for respiratory care equipment (including mechanical ventilators), and develop a strategy for acquiring additional equipment when needed.

We will anticipate needs for antibiotics to treat bacterial complications of influenza, and determine how supplies can be maintained during a pandemic.

We will establish contingency plans for situations in which primary sources of medical supplies become limited.

We will attempt to access state and national stockpiles.

We plan to test our mass fatality plans with local officials.

We will need to continue working with local health officials and medical examiners to identify temporary morgue sites.

Although the timing, nature and severity of the next

pandemic cannot be predicted with any

certainty, an influenza pandemic has the potential

to cause more death and illness than any other public health threat.

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In New York State at the peak of a moderate pandemic influenza outbreak (i.E. 35% attack rate, 6 week duration, excluding New York City) can expect:

14,916 influenza-related hospital admissions per week

3,728 influenza-related deaths per week 2,609 deaths in the hospital

In New York State influenza patients will most likely utilize:

63% of hospital bed capacity 125 % of intensive care capacity 65% of hospital ventilator capacity.

Step 1: Determine population of locale by age groups:Age Group Population0-17 yrs 8,865 18-64 yrs 61,546 + 65 yrs 9,483

Step 2: Determine basic hospital resources:Total staffed beds: 233 Staffed ICU beds: 14 Total number of ventilators: 40

Step 3: Determine duration (6, 8, or 12 weeks) and attack rate (15%, 25% or 35%) of the pandemic:Duration: Attack rate:

Step 4:

Notes: 1. Duration refers to the number of w eeks you assume the pandemic w ave to last.

2. Attack rate refers to the percentage of the population that becomes clinically ill due to influenza pandemic.

12 35%

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Assumptions:*

No. 1 Average length of hospital stay for influenza-related illness is 7 days.

No. 2 Average length of ICU stay for influenza-related illness is 10 days.

No. 3 Average length of ventilator usage for influenza-related illness is 10 days.

No. 4 An average of 15% of admitted influenza patients will need ICU care.

No. 5 An average of 7.5% of admitted influenza patients will need ventilators.

35%

425

150530

Total Deaths

82

42134

1 2 3 4 5 6 7 8 9 10 11 12

4 17 30 43 55 64 64 55 43 30 17 4

2 6 11 15 20 23 23 20 15 11 6 2

5 21 37 53 69 80 80 69 53 37 21 5

Hosp Adm. / Week

Most Likely ScenarioMinimum ScenarioMaximum Scenario

Influenza Pandemic Impact / Gross Attack Rate

Most Likely Scenario

Minimum Scenario Maximum Scenario

Total Hospital Admissions

Most Likely Scenario

Minimum Scenario Maximum Scenario

Distribution of admissions: By week, 12 week outbreak 35% attack rate

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1 2 3 4 5 6 7 8 9 10 11 12Weeks of outbreak

Wee

kly

adm

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Maximum

MinimumMost Likely

1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hospital Admission Weekly admission 4 17 30 43 55 64 64 55 43 30 17 4

Peak admission/day 10 10

Hospital Capacity # of f lu patients in hospital 4 17 30 43 55 64 67 62 53 41 28 15

% of hospital capacity used 2% 7% 13% 18% 24% 27% 29% 27% 23% 17% 12% 6%

ICU Capacity # of f lu patients in ICU 1 3 6 8 11 13 14 14 12 9 7 4

% of ICU capacity used 5% 20% 40% 60% 80% 95% 100% 99% 84% 66% 47% 27%

Ventilator Capacity # of f lu patients on ventilators 0 1 3 4 6 7 7 7 6 5 3 2

% usage of ventilator 1% 4% 7% 11% 14% 17% 18% 17% 15% 12% 8% 5%

Deaths # of deaths from flu 1 3 6 8 11 12 12 11 8 6 3 1

# of f lu deaths in hospital 1 2 4 6 7 9 9 7 6 4 2 1

Notes: 1. All results show ed in this table are based on most likely scenario.

2. Number of f lu patients in hospital, in ICU, and number of f lu patients on ventilator are based on maximum daily number in a relevant w eek.

3. Hospital capacity used, ICU capacity used, and % usage of ventilator are calculated as a percentage of total capacity (see manual for details).

4. The maximum number of f lu patients in the hospital in a w eek is greater than w eekly admission after the peak because w e assume a 7-day stay in

general w ards (see manual for details).

Influenza Pandemic Impact / Weeks

Total Hospital Admission (most likely)

425

Total Death (most likely)

82

Distribution of admissions: By day, 12 week outbreak 35% attack rate

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4

6

8

10

12

14

1 8 15 22 29 36 43 50 57 64 71 78Days of outbreak

Da

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Most likely Minimum scenario Maximum scenario

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