H1N1 out­break in 2009 pre­pared hos­pi­tals for lat­est flu sea­son

Hos­pi­tals feel pre­pared for surge

Modern Healthcare - - NEWS - Ashok Selvam

While hos­pi­tals face staffing chal­lenges be­cause of the sever­ity of the cur­rent flu sea­son, the lessons learned from 2009’s swine flu epi­demic have left them bet­ter pre­pared to han­dle this year’s out­break. Of­fi­cials for hos­pi­tals and the Cen­ters for Disease Con­trol and Preven­tion agree that this year’s flu sea­son isn’t as se­vere as in 2009—yet. But the rapidly chang­ing sit­u­a­tion still hasn’t peaked. Wide­spread flu ac­tiv­ity in­creased last week by one state to 48 states, ac­cord­ing to the CDC, which also re­ported 29 pe­di­atric deaths at­trib­uted to in­fluenza. The to­tal num­ber of pe­di­atric deaths from the full 2009 H1N1 sea­son was 282.

Most hos­pi­tals in­crease staffing dur­ing the flu sea­son in an­tic­i­pa­tion of an in­flux of pa­tients. They also need ad­di­tional healthy work­ers to step in for sick em­ploy­ees, with tem­po­rary health­care staffing agen­cies of­ten used to fill the breach.

Those groups are so far re­port­ing only a slight uptick in de­mand from this year’s out­break. Ralph Hen­der­son, pres­i­dent of AMN Health­care, a temp agency that works with sys­tems from as Kaiser Per­ma­nente and New York Pres­by­te­rian Health­care Sys­tem, said his agency “isn’t ex­actly see­ing a wind­fall” from the in­creased de­mand from this flu sea­son, but de­mand is up. “But it’s par­tially neg­a­tive— our em­ploy­ees get the flu, too.”

He es­ti­mates there is about a 20% in­crease in de­mand for temp work­ers across all de­part­ments dur­ing flu sea­son com­pared with the 2011

flu sea­son, in­clud­ing a higher de­mand for emer­gency room res­pi­ra­tory tech­ni­cians. AMN, with of­fices in Irv­ing, Texas, and San Diego, is see­ing a higher de­mand in pe­di­atric and ge­ri­atric-care de­part­ments, which mir­rors the de­mand seen in 2009. It also matches the two pa­tient pop­u­la­tions most at risk—young chil­dren and se­nior ci­ti­zens.

The ef­fort to limit hospi­tal-ac­quired in­fec­tions re­in­forces the need to keep sick em­ploy­ees at home. Work­ers at the Cleve­land Clinic’s fa­cil­i­ties suf­fer­ing from the swine flu in 2009 could re­turn to work only if a nurse granted them health clear­ance, said Dr. Paul Ter­peluk, the clinic’s med­i­cal di­rec­tor of em­ployee health ser­vices. Cleve­land Clinic of­fi­cials in 2009 used a nurse’s hot­line to track sick work­ers. Work­ers would call the hot­line and an­swer health-re­lated ques­tions be­fore tak­ing sick days. Em­ploy­ees were re­quired to call the hot­line again be­fore re­ceiv­ing the go-ahead to re­turn to work.

This sea­son, the clinic isn’t us­ing the hot­line since fewer em­ploy­ees are call­ing in sick. Ter­peluk noted that the em­ployee vac­ci­na­tion rate in 2009 was 50%. Ef­forts to pro­mote em­ployee flu shots since then have pushed the vac­ci­na­tion rate to 80% of the sys­tem’s 41,000 work­ers. The vac­ci­na­tion is not manda­tory. “We just al­lowed peo­ple to do the right thing,” Ter­peluk said. “We knew we were do­ing the right thing, and we felt peo­ple would fol­low that ex­am­ple.”

The Cleve­land Clinic’s pol­icy matches the Oc­cu­pa­tional Safety and Health Ad­min­is­tra­tion’s stance that calls for hos­pi­tals to pro­vide vac­ci­na­tions, but stops short of mak­ing it a re­quire­ment.

Al­ter­na­tively, Ban­ner Health in­sti­tuted a man­date in Septem­ber re­quir­ing vac­ci­na­tion. Of­fi­cials at Phoenix’s 22-hospi­tal sys­tem said they al­ready achieved a 100% com­pli­ance rate among its 37,000 em­ploy­ees, with 3% opt­ing to wear sur­gi­cal masks in­stead of get­ting the flu shot based on re­li­gious grounds or pre-ex­ist­ing con­di­tions, said Dr. Mar­jorie Bes­sel, med­i­cal di­rec­tor for Ban­ner’s east­ern Ari­zona re­gion. No one has been fired at Ban­ner for re­fus­ing a flu shot, but there have been a few fir­ings across the coun­try, in­clud­ing the ter­mi­na­tion this month of a nurse who re­fused manda­tory vac­ci­na­tion at In­di­ana Univer­sity Health Goshen.

Ser­vice Em­ploy­ees Union In­ter­na­tional is su­ing the Rhode Is­land De­part­ment of Health, which im­ple­mented its own vac­cine man­date in Oc­to­ber. Gen­er­ally, unions and other groups rep­re­sent­ing work­ers, such as Na­tional Nurses United and Amer­i­can Nurses As­so­ci­a­tion, en­cour­age its mem­bers to get vac­ci­nated. But they balk at a re­quire­ment—at least one that’s not ne­go­ti­ated as part of a la­bor con­tract.

“In this union en­vi­ron­ment, an em­ployee man­date can­not just be put into place as a re­quire­ment with­out be­ing ne­go­ti­ated with the union first,” said David Kurtz, a part­ner in Ed­wards Wild­man’s La­bor & Em­ploy­ment group in Bos­ton.

It’s too early to gauge the true im­pact of Ban­ner’s man­date, Bes­sel said, since the flu hasn’t hit Ari­zona and other states closer to the Pa­cific Ocean as hard as the East Coast. Ari­zona is among 10 states re­port­ing mod­er­ate flu ac­tiv­ity, with 30 states re­port­ing high ac­tiv­ity, ac­cord­ing to the CDC. Ban­ner plans to re­view its pro­gram in the spring.

“We’re very pleased that we were able to be or­ga­nized with really good im­ple­men­ta­tion to help us dur­ing what ap­pears to be a very hard flu sea­son,” Bes­sel said.


Dr. Meeta Shah at Chicago’s Rush Univer­sity Med­i­cal Cen­ter dons a mask be­fore see­ing a res­pi­ra­tory pa­tient amid the most se­vere flu sea­son since 2009.

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