H1N1 Influenza 2009: A descriptive study of the response of an influenza assessment clinic

collaborating with an emergency department in Australia

Jamie RanseLecturerDisciplines of Nursing and MidwiferyFaculty of Health University of Canberra

Phone: +61 (0)2 6201 5380Fax: +61 (0)2 6201 5128Email: jamie.ranse@canberra.edu.au Blog: www.jamieranse.comTwitter: jamieranse

research team

Mr Jamie Ranse1,2

Mr Shane Lenson3

Mr Matthew Luther4

Dr Lily Xiao1

1. University of Canberra2. Flinders University3. Royal College of Nursing, Australia 4. Calvary Health Care ACT

Research GrantACT Health: Practice Development Grant

overview

• Background• Aims• Method• Results• Discussion

background

• In June 2009 the WHO elevated their pandemic index to Phase 6.

• Worldwide as at February 2010:– 213 countries– 16,455 deaths

• Australia as at February 2010:– 37,700+ cases– 13% hospitalised (M = 31 yrs)– 14% of these required ICU (M= 40yrs)– 191 deaths (M=48 yrs)

background: emergency departments

• 30% increase in patient presentations• Change in function• Strategies

– Separate triage areas– Surge clinics– Influenza Assessment Clinic (IAC)

background: influenza assessment clinic

• Opened based on ED demand / trigger points• First day clinic on 26th May 2009• Monday – Friday; 0900 – 1700• Surge outside business hours• Collocated

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

Design• This study was retrospective in nature, utilising a

descriptive study design

Setting• Calvary Hospital is a 334 bed community hospital in the

city of Canberra, in the Australian Capital Territory• The public ED has approximately 45,000 presentations

per annum• Canberra is an inland city of approximately 350,000

people

method

Sample and population • Non-probability purposive sampling • All patients that presented to the Calvary Hospital IAC

and ED during the period of 3 June 2009 to 3 July 2009• Sample included all presentations from the above

population that presented with influenza-like symptoms, and included a total of 1106 persons

method: data collection

Data collection• Retrospectively from an existing ED patient information

system• IAC utilised an existing ED patient information system• An independent identifying code, as a data collection and

patient tracking tool. • Date, time, complaint, disposition and demographic

information.

method

Data analysis• Demographic characteristics for Descriptive statistics• t-test for interval data• Mann-Whitney U test for ordinal data• Chi-square test for nominal data

Protection of human participants• Approved by a human research ethics committee

results

Frequency of presentations

results

Frequency of presentations

results

Frequency of presentations

results

Demographics

results

Admissions and discharges

results

Admissions and discharges

results

Admissions and discharges

results

Caseload

discussion

• Increase in patient presentations on average of 36 per day; similar to the Victorian experience of a 30% increase

• Patients presented in the AM• Research should explore factors that influence patient

presentation times• IAC on a surge basis

discussion

• Patients who presented to the ED were younger (M=23) than the IAC (M=30)

• Few of the patients that presented were over the age of 65 (N=24/1106; 2.2%)

• Need to report nationally (ILS)

discussion

• A sustainable IAC like model needs to exist• Test models during seasonal influenza periods, rather

than a reactive composition during a pandemic response.• Prospective data collection

limitations

• A single Australian IAC and ED• Results may differ in differing influenza strains • Did not provide epidemiological information about the

attack rate of confirmed H1N1 2009

more information?

Australasian Emergency Nursing Journal

Australian Journal of Emergency Management

H1N1 Influenza 2009: A descriptive study of the response of an influenza assessment clinic

collaborating with an emergency department in Australia

Jamie RanseLecturerDisciplines of Nursing and MidwiferyFaculty of Health University of Canberra

Phone: +61 (0)2 6201 5380Fax: +61 (0)2 6201 5128Email: jamie.ranse@canberra.edu.au Blog: www.jamieranse.comTwitter: jamieranse