Posted by Guest Blogger on Fri, Dec 04, 2009 @ 05:06 PM
By Marty Ogle, M.D.
Here's some encouraging news for my emergency physician colleagues. According to a story in the LA Times, more than 38 million doses of vaccine for the H1N1 influenza are now available for ordering - 11 million more than last week and double the number available two weeks ago. These figures come from the Centers for Disease Control and Prevention. Another 8 million doses are expected to arrive this week, says Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases.
About 91 million doses of seasonal flu vaccine have also been shipped, and manufacturers expect to ship a record 114 million doses before the season is over, she said.
The not so good news is that widespread influenza activity is being seen in 48 states and, according to Dr. Schuchat, virtually all of those cases are H1N1. Influenza-like illnesses during the first week of November accounted for 7.7% of visits to doctors' offices, down slightly from 8% the week before, but still much higher than in a "normal" flu season.
Other interesting stats:
- More than half of the hospitalizations continue to be in people under are 25.
- 90% of the deaths are in people under 65. In a typical flu season, the majority of deaths are in those over 65.
- There have now been 129 pediatric deaths from laboratory-confirmed swine flu, and the number is increasing.
The CDC has ordered 10,000 treatment courses of the intravenous antiviral drug peramivir for its national stockpile. Meanwhile, the Food and Drug Administration approved emergency use of the experimental drug for severely ill patients who for one reason or another cannot use the oral or intranasal antivirals.
All of which means, the H1N1 pandemic is definitely here. Even cats are getting it. Emergency rooms need to be ready - not just for H1N1 cases, but for seasonal flu cases. While the best way to combat the flu is to stay home until symptoms are gone, it's unlikely most people will do this (especially in this economy where many folks are afraid to miss work). The bottom line is we need to be on our toes for a long winter.
How is your emergency department coping with H1N1? Is your vaccine allocation keeping pace with need? Please forward your comments.
Posted by Guest Blogger on Fri, Dec 04, 2009 @ 12:52 PM
By Prentice Tom, M.D.
Flu season officially begins October 4, 2009. With the new H1N1 virus, it is predicted that hospital emergency departments and emergency physicians could see a substantial increase in flu/flu-like illness patients.
The CDC estimates that 40%-50% of the population may be infected by the H1N1 virus in the next two years. Regardless of the actual percentages, it is clear that emergency departments need to be ready for what could be an onslaught.
CEP America has developed a plan to partner with our hospitals throughout the country to address the demand for emergency care resulting from a flu pandemic. It calls for:
- Recommendations for increasing ED staffing using "phantom shifts," call back and call schedules, and phone trees.
- An evaluation/treatment algorithm based on CDC and other published guidelines, as well as links to pertinent H1N1 information websites, and an example of a patient discharge instruction sheet.
- A mechanism for employing community primary care physicians already on staff to help treat flu/flu-like illness patients in the auxiliary treatment areas on the hospital campus.
Successfully addressing prolonged ED volume surge due to a pandemic is a complex problem that requires close alignment between emergency physicians and hospitals. Developing the ability to employ community physicians to help staff disaster treatment areas is one way we can partner with our hospitals and engage the medical community in addressing this possible crisis.
I look forward to your comments and suggestions on what your hospitals or communities are planning.
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 05:08 PM
By Nancy Burghart-Hall
With the ever-increasing demands put upon this nation's emergency departments, the challenge of implementing information technology has never been greater. And the challenges will continue to grow if the H1N1 pandemic comes to pass.
During "normal times", IT is touted to enable an ED's administrative and managerial systems to function more efficiently. In addition, software vendors tell us how clinical applications can lead to systems that more quickly capture patients' data into an electronic medical record - including the diagnosis coding, medications, and discharge summary. However, practical experience is showing us different, and the administrative overhead added to the workload by information technology often times slows down a productive ED.
Taken a step further, what will happen during extraordinary circumstances like a natural disaster or the predicted H1N1 pandemic - both of which create an onslaught of new patients?
Will our information technologies prove themselves as useful tools to help keep emergency rooms from being overwhelmed, or will our systems be even more disruptive and clog the ED during times of stress? Will your ED be able to effectively manage a pandemic using your current IT infrastructure?
The answer is "probably not". In which case, I have a couple of suggestions that are not necessarily "high tech" but have been shown to be helpful in expediting the online documentation and EDIS systems process.
Scribe programs:
A scribe is "a physician collaborator who fulfills the primary secretarial and non-medical functions of the busy emergency physician." Scribe programs have been shown to benefit ED doctors and their patients tremendously, expediting the ED process by as much as 30%-40%. During times of high stress, having a scribe program in place can be beneficial. For a thorough overview of how scribe programs work, visit: http://bit.ly/30wWLi
Voice Activation:
Medical records serve many crucial purposes. Besides a description of the clinical scenario and therapy, they serve to justify care to insurance companies and managed care organizations. It's important to note that hospitals and physicians are paid not by what they do for the patient, but how well what they do is documented. Voice Activation can support the documentation process, creating a higher quality chart.
So during a pandemic, how can an emergency physician quickly generate a comprehensive, accurate and legible medical record? Both Scribes and Voice Activation are tools to help you do this.
Is your ED's IT infrastructure up to the task? I'd love to hear your thoughts and learn about the systems you have in place. I'm also happy to share more information - just ask!
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 05:05 PM
By Dan Culhane, M.D.
Is your emergency department ready for the H1N1 pandemic? It's back in the news and for most ED physicians and nurses it's most likely back in our minds. If the numbers are correct and your ED isn't prepared, this could be a very trying flu season in America.
According to a recently released presidential advisory report, The H1N1 virus could cause up to 90,000 U.S. deaths this fall - mainly among children and young adults.
The report states that the H1N1 virus, commonly known as swine flu virus, could infect between 30% and 50% of the American population during the fall and winter. They're saying 60 million to 120 million Americans could be infected, 30 million people infected but without symptoms, and up to 1.8 million Americans may be hospitalized. Visit http://www.ostp.gov/cs/hometo read the complete report.
H1N1 resurgence may happen as early as September at the beginning of the school year, and infections may peak in mid-October. However, the H1N1 vaccine isn't expected to be available until mid-October, and even then it will take several weeks for vaccinated individuals to develop immunity, the report says.
Infections may increase as early as August as some pupils return to school, according to the Centers for Disease Control and Prevention in Atlanta.
So what does it all mean to emergency rooms across the country? We could well be seeing a huge influx of sick or "think they're sick" people. And though the report urges speedier production of the H1N1 vaccine and the availability of some doses by September, the virus will likely get to a lot of people before the vaccine does. In fact, hospitals could suffer "severe disruptions", the White House warned.
While the focus on H1N1 prevention is good, the problem is, once the media frenzy gets into high gear, it's going to cause panic - when in fact people need to exercise common sense and go to the emergency room only if they need that level of care. Otherwise, it's going to overload a system that's already overloaded.
So prepare yourself and your emergency department. Perhaps doctors need to create their own campaign around avoiding the ER - "if you're not sick, it's a lot easier to catch germs in a waiting room than if you stayed home".
Please let me know your thoughts
Posted by Guest Blogger on Thu, Dec 03, 2009 @ 04:57 PM
By Joel A. Stettner MD.
Now that the healthcare reform discussion has taken center stage, what about the "Major Healthcare Issue" that preceded it last year? By that I mean the novel H1N1 outbreak, more popularly known as "swine flu".
With fall quickly approaching, the issue will likely be on the front burner again. But a recent article in the Washington Post states that most Americans are not very concerned about swine flu.
While we Americans are well known for our short attention spans, should we be more worried? Or are we too entranced by other distracting issues such as Sarah Palin and her "Death Panel"?
The CDC reports that from April 15, 2009 to July 24, 2009, there were a total of 43,771 confirmed and probable cases of novel influenza A (H1N1) infection in the U.S. Of those, 5,011 people were hospitalized and 302 people died.
The tone of the report does not convey a sense of concern by the CDC. In fact, they have completely discontinued their confirmed and probable case counts, though aggregate national reports of hospitalizations and deaths are continuing. Their recommendations for avoiding the pitfalls of an H1N1 outbreak include avoiding sick people, washing hands frequently and covering faces with tissue when sneezing. Final recommendations on vaccination are still pending, as are details on vaccine availability.
However, the World Health Organization sees it differently. According to a recent report http://bit.ly/FYdVF the global spread of H1N1 swine flu will endanger more lives as it speeds up in the coming months. They're telling governments to boost preparations for a swift response and are predicting an explosion in case numbers.
So which is it? Should we be concerned or should we consider the current H1N1 outbreak to be simply business as usual? My feeling is that this is a potentially serious disease (especially for the at-risk groups). I think that preparation for likely patient visit surges is very important; we must find ways to more rapidly see those with mild infections and quickly move admitted patients out of the ED. Preparation now could be critical as the traditional flu season approaches.
I look forward to your comments!