Health Information Networks and Drive-Through Flu Clinic: Two Ways to Manage Surge of Emergency Patients During Pandemic

Health information exchanges and drive-through influenza clinics may help emergency physicians cope with sudden surges of patients during a disease outbreak, such as the pandemic H1N1 flu of spring 2009. Researchers are reporting on electronic biosurveillance in New York City and a model drive-through flu clinic in California today online in Annals of Emergency Medicine (“Health Information Exchange, Biosurveillance Efforts and Emergency Department Crowding During the Spring 2009 H1N1 Outbreak in New York City” and “Drive-Through Medicine: A Novel Proposal for Rapid Evaluation of Patients During an Influenza Pandemic”).

“Eleven emergency departments who are members of the New York Clinical Information Exchange (NYCLIX) electronically reported daily visit rates from the peak of the H1N1 outbreak in spring of 2009,” said lead study author Jason S. Shapiro, MD, of the Department of Emergency Medicine at Mount Sinai Hospital in New York. “The increase in daily visits during two distinct periods occurred almost simultaneously in all emergency departments, with a peak of more than 60 percent above normal for that time of year. Looking ahead, this type of biosurveillance may provide public health agencies and hospitals more timely information than what they currently receive using traditional manual reporting and allow them to respond to crises more swiftly.”

 Researchers analyzed the NYCLIX database for emergency department visits from March 15 through July 15, 2009. Sites reported an increase in daily visits in two distinct peaks: the first following reports of the first case of H1N1 in New York City on April 25, 2009 and the second following reports of the first H1N1 death in New York City on May 17, 2009.

 “The crowding in emergency departments that is already a public health crisis was exacerbated by unprecedented surges of patients during the H1N1 pandemic in New York City last spring,” said Dr. Shapiro. “When patients are flooding through the doors of an emergency department during a disaster, we need to respond quickly and effectively. Electronic biosurveillance is faster and more effective than manual reporting. If we know what’s coming, we can prepare for it.”

 In California, where H1N1 also hit hard, researchers set up and ran a model drive-through flu clinic in a parking garage. Using charts from actual patients who had visited the Stanford University emergency department during the H1N1 outbreak in April 2009, researchers registered, triaged, screened and discharged actors playing patients. Average length of stay was 26 minutes, with doctors who participated in the exercise actually improving the time to discharge as the exercise went on.

 “In our model, the drive-through influenza clinic rapidly evaluated patients while mitigating the person-to-person spread of infectious disease,” said lead study author Eric A. Weiss, MD, of Stanford University School of Medicine in Palo Alto. “The patient’s vehicle becomes a self-contained isolation room as well as a moving examination room that alleviates the delay inherent in turning over a fixed number of rooms and spaces with the hospital. A drive-through influenza clinic is an alternative care center with many advantages and few limitations. It could also be used in a bioterrorism event.”