Our ER physicians and nurses were on the front lines screening and caring for patients during the H1N1 crisis. Debra Davies, Nurse Manager, Emergency Department, Toronto General Hospital, and Dr. Anil Chopra, Medical Director, Emergency Medicine, share some of their lessons learned from the pandemic.
Debra Davies
A lesson learned was that electronic tools are really helpful. We were able to generate reports for IC clinicians telling them how many patients who failed the screening came in, how many were admitted to hospital, and where they went. So we had good follow-up on patients who moved through the hospital. That was something we didn't have with SARS and never had before—to actually track the movement of patients who had failed screening, which was a benefit to the organization. It's not going to end with H1N1: We are going to continue to do this as part of daily practice.
Another lesson learned was you have to follow good practices all the time and not just when you have an outbreak. It has to be part of your daily assessment. We can't let that waver because we think this particular episode of H1N1 is over.
Dr. Anil Chopra
ED is a busy, bustling area. Infection control traditionally has not been the most important factor we look at in terms of assessing, managing and dispositioning patients. But after SARS, and now with this pandemic planning, our awareness of how careful we need to be in terms of improved infection control and prevention practices in the ED really heightened—to prevent health-care workers from acquiring the virus, and to prevent the dissemination of the virus from the index case to others in the hospital.
The second lesson was the ability of the institution to meet the need to prepare for this. We did this very collaboratively with other departments and services. We met people we didn't even know existed. So we learned how effective preparedness can be when it is done in a collaborative fashion.
The third lesson was that our caseload was primary young, healthy patients with flu-like illness who could be managed in the ED almost exclusively and be discharged home. Our initial worry was that we would be inundated with a large number of sick patients, of which many would have to be intubated and ventilated, and that we would outstrip our supply of ventilators and ICU capacity and be unable to meet the demand. The lesson was that, in fact, the majority of patients weren't that sick and didn't need admission.
