Saturday, December 04, 2010

Making Pandemic Influenza Plans Visible

The report "Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments", indicates that most Australian hospitals had a plan to deal with such an emergency, the plans were activated and were useful. But 43% of hospital staff in did not know the plans existed or were in force. There were also inconsistencies found in plans between different parts of the health system, both between GPs and hospitals and also different specialists in the hospitals. The report emphasised the importance of community and public health involvement and communication strategies. One obvious tool to use is the web. Plans for such health emergencies should be published online. The documents should be in an easy to read format which doctors (and others) can read on their smart phones. Online consultation tools can be used to get wide input. This might provide a useful case study for COMP7420: Electronic Data Management.

On 25 April 2009, the World Health Organization (WHO) determined that
member states and partners should increase their surveillance programs and
prepare for an epidemic14. Australia activated its pandemic plan, The Australian Health Management Plan for Pandemic Influenza 2008 (AHMPPI 2008)19, in line with this recommendation15. ...

There is contradictory information in pandemic plans devised for different sections of the health care system. For example a 2003 survey, undertaken on behalf of the Australian and New Zealand Intensive Care Society, identified hospital EDs as additional short-term bed spaces for ventilated patients in the event of a pandemic8. This ignores the issue that, during a pandemic, EDs have increased demand on their space and resources and cannot be expected to also function as satellite ICUs. ...

Pandemic plans

About two out of five (39%) of respondents reported that they knew that their hospital or ED had a written pandemic plan before the onset of the (H1N1) 2009 influenza pandemic as shown in Table A-8. In most cases, these plans were part of a hospital plan, but 50 respondents did report working in an ED with a stand-alone ED pandemic plan. Notably, a large proportion (43%) of respondents did not know whether a plan existed for their department or hospital. These responses differed strongly by discipline, with more than three-fifths of registrars (62%) falling into the ‘don’t know’ category, compared to only 33% of SMOs, and 34% of nurses.

Of those reporting the existence of a pandemic plan, two-thirds (66%) knew that it had been activated during the (H1N1) 2009 influenza pandemic, and 19% knew it had not been activated. The remaining 15% did not know the status of the pandemic plan activation in their department. Of those reporting an activated plan, the overwhelming majority (98%) stated that it had been at least somewhat useful in dealing with Pandemic (H1N1) 2009 Influenza. The overall mean score was 3.6 on the 5-point scale ranging from ‘not at all useful’ to ‘very useful.’ Again, registrars were more likely to report not knowing whether the pandemic plan had been activated. ...

Pandemic plans

The parts of pandemic plans found useful by respondents included the policies, procedures, and protocols, which had been set up in advance of the pandemic. These included guidelines for triage, isolation, cohorting, proper use of PPE, and other infection control measures. Arrangements for obtaining extra staffing and more PPE were also welcomed, as was the provision of separate triage and flu clinics.

Limitations to pandemic plans included a lack of specificity to individual hospitals, Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments. 38 with some hospital designs making them difficult or impossible to implement, particularly with respect to the isolation of potentially infectious patients and appropriate patient flow from triage, through the department, and home or to wards. Many respondents stated that the plans were designed for a far more virulent disease. Plans also did not take pre-existing heavy workloads into account.

Suggestions for the future included greater involvement in planning of major stakeholders including EDs, GPs, public health, infection control, and pathology clinicians, as well as members of the community. Participants recommended implementing procedures to divert patients who could more properly be seen by GPs and establishing flu clinics out of EDs. Better stockpiling and release of PPE and antivirals was also mentioned, together with separate flu clinics close to EDs, with some designated flu hospitals. Respondents felt there should be more preparation and practice of any future plans. They also raised issues about creating surge capacity within hospitals, particularly by addressing the pre-existing problem of access block, and the necessity of special pandemic funding in the event of a pandemic. ...

Pandemic and disaster plans

All but one of the directors reported that a pandemic plan was in place for their department before Pandemic (H1N1) 2009 Influenza, as shown in Table B-3. Of the 11 plans, 10 were part of a general hospital plan and one was a stand-alone ED plan. In seven out of ten cases, the pandemic plan was activated during the (H1N1) 2009 influenza pandemic, and amongst these responses, most directors found the plan useful. In responding to open-ended questions about what was specifically useful, or not useful, about the activated pandemic plan, directors referred to clear guidelines (e.g. for triage), lines of responsibility, setting up a ‘fever clinic’, and the involvement of other areas of the hospital, as being useful. Several of those mentioning the ‘not useful’ aspects of their pandemic plan also referred to other members of their hospital’s staff, saying, for instance, that they had not shared the load. Also mentioned as problematic was the lack of staff management strategies, and that
staff had not been pre-fitted for respirators.

Directors were given the opportunity to make suggestions for developing ED-related pandemic plans for managing future pandemics. Directors of Emergency Medicine recommended that flu clinics be established early, so that EDs are not required to deal with the full volume of patients. They pointed to the critical importance of community and public health involvement from the beginning. Improvement in communication strategies was also mentioned, as was better provision of isolation facilities within EDs and better staff management strategies (filling in, redeployment,

Directors were also asked whether their hospital’s formal disaster plan had been activated during the (H1N1) 2009 influenza pandemic. No disasters plans were activated. ...

Of significance was the relationship between the pandemic planning approach and disaster planning. A small proportion of staff reported the activation of their organisation’s disaster plan. Some individuals felt activating disaster plans would have delivered a higher level of support. The relationship between pandemic and disaster planning needs to be clarified. ...

From: "Pandemic (H1N1) 2009 Influenza Outbreak in Australia: Impact on Emergency Departments". FitzGerald, Gerard and Patrick, Jennifer R and Fielding, Elaine L and Shaban, Ramon Z. and Arbon , Paul and Aitken, Peter and Considine, Julie and Clark, Michele J. and Finucane, Julie and McCarthy, Sally M and Cloughessy, Liz and Holzhauser, Kerri (2010), QUT, Brisbane QLD Australia.

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