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Was the Pediatric Emergency Department or Pediatric Urgent Care Center Setting More Affected by the Fall, 2009 H1N1 Infl

Was the Pediatric Emergency Department or Pediatric Urgent Care Center Setting More Affected by the Fall, 2009 H1N1 Influenza Outbreak?. G. Conners, MD, MPH, MBA; T. Hartman, MHA; M. Fowler, MD; L. Schroeder, MD; T. Tryon, MD Children’s Mercy Hospitals & Clinics, Kansas City, MO.

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Was the Pediatric Emergency Department or Pediatric Urgent Care Center Setting More Affected by the Fall, 2009 H1N1 Infl

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  1. Was the Pediatric Emergency Department or Pediatric Urgent Care Center Setting More Affected by the Fall, 2009 H1N1 Influenza Outbreak? G. Conners, MD, MPH, MBA; T. Hartman, MHA; M. Fowler, MD; L. Schroeder, MD; T. Tryon, MD Children’s Mercy Hospitals & Clinics, Kansas City, MO

  2. Background • The H1N1 influenza outbreak of Fall, 2009 stressed the resources of our pediatric emergency department (PED) and two pediatric urgent care centers (PUCCs). • As the leaders of the Division that manages both areas, we had to make PED versus PUCC resource allocation decisions based on guesswork, rather than data.

  3. Background • We sought to learn from our experience, in order to determine whether the PED or the PUCC setting had been more affected, to help guide future decision-making. • Our areas of focus for this analysis: • overall volumes (# patients registering) • rates of elopement (either left before seen or during evaluation)

  4. Setting • Free-standing, academic children’s hospital in Kansas City, MO: • Main hospital: ~70,000 annual visit PED • Northland: multiple pediatric sub-specialty clinics in North K.C., including a noon-10 PM PUCC (~23,000 / yr) • South: multiple pediatric sub-specialty clinics / inpatient beds in Overland Park, KS, including a 24/7/365 PUCC (~55,000 / yr)

  5. Methods • Fall, 2009 H1N1 influenza outbreak period: 8/1/09 – 11/15/09 • Using an administrative database, we compared patient data during this period with those of the same dates in 2008: • Patients who registered* (volume) • Rates of patients who eloped (either left before seen or during evaluation) • We combined data from the two PUCC sites *We adjusted (increased) the Fall, 2008 Northland PUCC volume by 8.6%, to account for increased service hours in Fall, 2009 versus Fall, 2008 (adjustment determined by comparing 12/09-3/10 with 12/08-3/09)

  6. Methods • We statistically compared overall patient volumes using chi-square test, and changes in elopement rates using Poisson regression. • Our IRB deemed this a quality improvement project, not subject to IRB approval.

  7. Results: Volume PUCC increase > PED increase p<.0001

  8. Results: Elopement Rates PUCC rate increase > PED rate increase p<.0001

  9. Results • Both the PED and PUCC settings experienced substantial surges in patient volume and elopement rates during the Fall, 2009 H1N1 influenza outbreak.

  10. Results: Volume • The PUCC setting had both a larger absolute increase (5057 versus 3230) and relative increase (26.0% versus 17.4%) in patient volume than did the PED during the Fall, 2009 H1N1 influenza outbreak.

  11. Results: Elopement Rates • The PUCC setting had a larger elopement rate increase (172% for PUCC versus 58% for PED) and nearly as large an absolute elopement increase (552 for PUCC versus 598 for PED) than did the PED during the Fall, 2009 H1N1 influenza outbreak.

  12. Discussion • Q: Was the PED or the PUCC setting more affected by the Fall, 2009 H1N1 influenza outbreak? • A: The PUCC!

  13. Discussion • This suggests that, when allocating resources between the PED and the PUCC during a large-scale influenza (or similar) outbreak, the PUCC should receive a substantial, and perhaps a majority, share.

  14. Two Major Limitations • We have measured and compared the quantity, not the quality, of the effects of the Fall, 2009 H1N1 outbreak on PED and the PUCC. Related issues: • who came to each setting for care • acuity differences • who eloped, and why? , etc.

  15. Two Major Limitations • Inherent limitations of our research design: before-after study using an administrative database. Related issues: • changes in other factors between 2008 / 2009? • accuracy of administrative data? • the baseline adjustment we made, etc.

  16. Conclusions • Both the PED and PUCC were very affected by the Fall, 2009 H1N1 influenza outbreak. • In terms of volume of patients seen and increase in elopement rates, the PUCC setting was more affected than the PED setting. • Although not the whole story, given the limitations, this information will be useful when allocating resources in future, similar situations.

  17. Thank you!

  18. Thank you! Questions?

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