H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia

Background: In June 2009, the World Health Organisation elevated their pandemic index indicating that the spread H1N1 2009 influenza was global. Many emergency departments (EDs) implemented strategies to divert patients with influenza-like symptoms, such as having separate triage and treatment areas. The establishment of influenza assessment clinics (IAC), also known as fever clinics, was a common strategy to achieve this diversion and separation. Calvary Health Care ACT (Calvary Hospital) established an IAC, supported predominately by ED nursing staff, as a strategy to enhance the health response capacity to H1N1 2009 influenza.

Aim: This study described the profile of patients presenting to the IAC and ED with influenza-like symptoms, and tested the relationships that influenced the collaboration between the IAC and ED.

Method: This was a retrospective, descriptive study using the existing patient information system to collect data. The sample for this study included all patients that presented with influenza-like symptoms to the IAC or ED during the IAC operational period; 3 June 2009—3 July 2009.

Results: 1106 patients presented with influenza-like symptoms during the study period, 967 (87.4%) presented during the operational times of the IAC (0900—1700). Patients who presented to the ED were younger than those who presented to the IAC (p = 0.001). A significantly higher proportion of patients presented in the morning period (0900—1300) in comparison to any other time (p<0.0005). Proportionately, the ED admitted more patients to hospital than the IAC (p< 0.0005). However, there were a significantly higher proportion of discharges from the ED than expected (p<0.0005).

Conclusions: Most patients with influenza-like symptoms presented during the operational hours of the IAC. Commonly, this was during the morning period which has staffing and resource implications in order to enhance the ED response capacity. A large proportion of patients were aged less than 65 years of age. Triage processes and guidelines should be enhanced to stream patients according to their likely disposition. A sustainable IAC like model should be implemented to support situations where increased ED patient presentations are experienced or expected. An evaluation of such a model should occur outside pandemic or increased patient presentation periods as this is the first study to provide an understanding of the relationship between an ED and IAC during the H1N1 2009 influenza pandemic. The results have staffing and resource implications, in order to enhance the ED response capacity.

Reference: Ranse J, Lenson S, Luther M, Xiao L. H1N1 2009 influenza (human swine influenza): A descriptive study of the response of an influenza assessment clinic collaborating with an emergency department in Australia. Australasian Emergency Nursing Journal. 2010;13(3):46-52.