Process over Chaos with Flu Season in Full Swing

The holiday season is over and flu season is in full swing.  Experts from the Centers for Disease Control and Prevention say things may get worse before they get better due to an imperfect vaccine and exceptionally cold weather.  And this means that hospitals from California to Maine are dealing with surging EDs—leading to challenges with everything from long wait times to overnight holds to inpatient admission delays.

In fact, some health systems are seeing a 16% increase in ED visits and almost a 40% increase in acuity [according to Brittany Lindsey, Director of Patient Flow, UAB Hospital, Birmingham, AL].  "We have setup our PACUs as additional ICUs, we are looking at staffing our EP cardiology unit as a flu unit, we are using our Post Recovery for our Heart and Vascular Center as a 23 hour bedded outpatient location, and certain floors of our women’s hospital have been converted to regular acute care for all genders," according to Lindsey.

While every disaster - and every health system - is certainly unique, there are some common themes that emerge for planning and managing through such pressures. 

A few tips from our patient flow experts include:

• Urgent care facilities are a good option for less serious cases. Create a flyer and/or an education program for your staff on how to advise patients on which facility can best meet their needs.
• Closing lobbies and family waiting areas to stop the congregation of people—and limiting the number of visitors to one consistent family member.
• Staff meetings at the start of every shift in order to make necessary adjustments quickly are helpful. This may require flexibility on the part of staff members—working longer shifts or shifting from an administrative role back to the bedside.
• Plans and planning committees should always be in place - with representatives from every department.  Planning for equipment and supply needs should also be addressed regularly.
• Building zones or designated areas for the influx of patients ahead of time will help with the order and placement of these patients.
• Badging patients and using attributes [ex. flu] upon admission to track patients and their interactions [ex. with staff and other patients] is key.
• Collaborate with your epidemiology department to identify the types and strains of flu you’re seeing.

For health systems Command Centers [centralized operations], real-time communication and visibility is essential to ensuring the continued smooth placement of patients:

• An ED [emergency department] dashboard should be visible to all.  And, dashboards in the ED and on all nursing units have proven beneficial to those managing the placement and whereabouts of patients.
• Once 'disaster' protocols are activated, the following should be readily available:
  • bedboard showing all units and all available beds
  • pending and confirmed patient discharges to determine if there are patients whose discharges can be expedited
  • projected census - by enterprise, facility, service line and unit
  • blocked bed report including reasons as there may be an opportunity to un-block those rooms
  • patient log of pending transfers from other facilities
• Having a clinician from the Transfer Center as an active, key member of the response team to provide real-time updates regarding activities is vital.

The University of Minnesota’s Center for Infectious Disease Research and Policy is a good resource to turn to for the latest information on the current outbreak, as is The Centers for Disease Control and Prevention - on providing detailed information on steps to minimize potential exposure before and during visits to healthcare facilities, how to monitor and manage ill employees, precautions that should be implemented, and working with environmental services on effective cleaning and disinfection procedures.

And one final—and extremely important—tip.  Even though flu season is already bearing down in a big way, it’s still not too late to get a flu shot.  Encourage your staff [and all other friends, colleagues and relatives!] to take this simple, preventive step.