Outside the Box and Into Thick Air: Implementation of an Exterior Mobile Pediatric Emergency Response Team for North American H1N1 (Swine) Influenza Virus in Houston, Texas
Received 30 June 2009; received in revised form 28 July 2009; accepted 4 August 2009. published online 19 October 2009.
Study objective
We describe the implementation of a mobile pediatric emergency response team for mildly ill children with influenza-like illnesses during the H1N1 swine influenza outbreak.
Methods
This was a descriptive quality improvement study conducted in the Texas Children's Hospital (Houston, TX) pediatric emergency department (ED), covered, open-air parking lot from May 1, 2009, to May 7, 2009. Children aged 18 years or younger were screened for viral respiratory symptoms and sent to designated areas of the ED according to level of acuity, possibility of influenza-like illness, and the anticipated need for laboratory evaluation.
Results
The mobile pediatric emergency response team experienced 18% of the total ED volume, or a median of 48 patients daily, peaking at 83 patients treated on May 3, 2009. Although few children had positive rapid influenza assay results and the morbidity of disease in the community appeared to be minimal for the majority of children, anxiety about pandemic influenza drove a large number of ED visits, necessitating an increase in surge capacity. Surge capacity was augmented both through utilization of existing institutional resources and by creating a novel area in which to treat patients with potential airborne pathogens. Infection control procedures and patient safety were also maximized through patient cohorting and adaptation of social distancing measures to the ED setting.
Conclusion
The mobile pediatric emergency response team and screening and triage algorithms were able to safely and effectively identify a group of low-acuity patients who could be rapidly evaluated and discharged, alleviating ED volume and potentially preventing transmission of H1N1 influenza.
aSection of Emergency Medicine, Baylor College of Medicine, Houston, TX
bSection of Infectious Disease, Baylor College of Medicine, Houston, TX
cDepartment of Pediatrics, Baylor College of Medicine, Houston, TX
Author contributions: ATC, BP, MCD, JES, and PES organized the study. ATC, BP, MCD, CRC, and GJD-H participated in data collection. ATC, BP, and MCD analyzed the data. ATC drafted the article, and all authors contributed substantially to its revision. ATC had had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. ATC takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
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Please see page 24 for the Editor's Capsule Summary of this article.
Publication date: Available online October 17, 2009.
ABSTRACT