NHS applying lessons learned from SARS to combat H1N1 pandemic
Posted By RAY SPITERI Review Staff Writer
Updated 2 months ago
It's too early to hand itself a passing grade for its H1N1 pandemic response, but the Niagara Health System has incorporated a number of lessons learned in the wake of the 2003 SARS outbreak in Toronto.
The new emergency department at Greater Niagara General Hospital was designed to handle more patients, which has come in handy as the health system has seen a spike in admissions related to the H1N1 flu virus.
The $15-million ER, built in 2007, also has a separate waiting area and four treatment rooms designed for patients suspected of having contagious illnesses.
The area and isolation rooms are connected to a separate "negative pressure" air-handling and filtration system that can prevent germs from spreading to adjoining rooms or hallways.
The infection-control systems built into the facility mean the new ER provides a safer environment for staff, patients and their families, says Tracy Fattore, the health system's regional director of risk management.
"One of the essential components of a pandemic plan is that you have the ability to separate your flu from your non-flu patients," she says. "That is a process that was initiated across the NHS at registration points, at the triage, in our ERs and our urgent care centres."
Once a patient arrives at the ER entrance, a nurse will ask a set of questions to gauge the type and seriousness of the person's illness.
If flu is suspected, the patient is sent to a specific waiting room, separate from the rest of the waiting area. From there, the person is sent to one of the isolation treatment rooms.
"That's a process that was implemented through SARS and has maintained standard process," says Fattore.
While SARS was largely confined to hospitals in Toronto, restrictions were placed on hospitals across Canada, even more so than what's been seen recently with the prevalence of H1N1.
SARS and H1N1 both deal with respiratory illness, but there are differences between the two, says Fattore.
"SARS was really about containment – containment of the disease itself versus pandemic or H1N1 where the focus is really on capacity and having the capacity to treat the numbers of patients that we'd expect to see," she says.
"Although they're both emergency situations, the fundamental premise of how you treat and manage the patients in a pandemic is somewhat different than what we experienced in SARS."
One of the more important lessons to come out of the SARS predicament was the importance of communication between medical health officials and their external partners, says Fattore.
She says SARS made it clear a well thought out plan was needed before the next pandemic swept around the planet.
In particular was the need to ensure good cooperation between critical agencies so that when a crisis hit, everyone knew their jobs.
"For us here at NHS, what that meant was having a routine process for all of our sites and all of our programs to participate in what we called the command centre," she says. "That allowed us to link not just all of our sites together and all of our programs, but also linked us to daily calls with public health and our external partners."
That protocol wasn't in place before SARS, says Fattore.
"What we learned during SARS was that there was information that was flowing, but there wasn't a consistent process or mechanism for the information to consistently move through organizations."
During the recent H1N1 outbreak, every morning at 10 a.m., about 30 to 50 NHS officials participate in internal calls before linking up with public health and other partners during the afternoon.
Health agencies also receive regular information from the Ontario Ministry of Health and Long-Term Care.
"This cycle itself is a direct outcome of the SARS experience," says Fattore. "We've tested this process internally and we actually had the opportunity to use it when we activated our pandemic plan."
To get a grip on the growing number of people turning to the NHS with flu-like symptoms recently, the health system opened a flu assessment clinic in St. Catharines for those with minor flu symptoms.
Niagara has been one of the hardest hit regions for influenza-like symptoms in the province.
Nurses were calling in sick as more patients were showing up at NHS facilities needing medical attention.
The flu clinic at the Ontario Street NHS site was set up to try and move less serious patients away from emergency rooms and prompt-care centres. More than 400 visits were made to the flu assessment centre between Nov. 2 and 15, the day it closed.
"We were probably one of the first ones in the province to establish (a flu assessment centre)," says Frank Demizio, the health system's corporate lead for infection control.
"We worked closely with public health and the ministry to put that up and it met our needs. We didn't know exactly what sort of the surge would be and this would allow the overflow, should there be, off of our emergency and even the physicians offices too at the same time."
The redeployment of staff in the event of a pandemic was something the NHS had also been planning for, says Demizio.
But the sheer volume of patients was unexpected. Combined with a staff shortage because personnel were coming down with the flu, the situation exceeded predictions.
As a result, the hospital system eventually had to resort to overtime to ensure essential services were covered.
Staff redeployment meant cancelling some non-emergency surgeries.
Stricter infection control measures reduced the number of visitors to hospitals, enforcement of handwashing for those who did visit and, in some cases, required they wear medical masks.
Now that the second wave of H1N1 cases appears to be over, life is returning to normal at the NHS.
Demizio says the plan, however, can be reactivated at a moment's notice if the situation changes.
"The experiences that we've been able to gain from the last couple of months will put us in good stead to go back to what we need to do," he says.
Meanwhile, the impact the H1N1 pandemic has had on the NHS budget, as well as how many patients have been admitted to hospital with the H1N1 flu virus to date and how well the overall NHS pandemic plan has gone is still being worked out, says Fattore.
"We're still doing that analysis. We're still not completely through it, so we actually want to take a couple more weeks to finalize and get through the curve and get those numbers all finalized.
"We will be completing a formal debrief process and doing a full analysis and learning from the process as much as we can to tweak our plans."
– with files from Sun Media
