Increasing out-of-hospital regional surge capacity for H1N1 2009 influenza A through existing community pediatrician offices: a qualitative description of quality improvement strategies.
OBJECTIVE
To describe initiatives undertaken by a network of community pediatricians to increase a city's surge capacity for patients presenting with influenza-like illnesses during the 2009 H1N1 influenza A pandemic.


METHODS
This was a descriptive quality improvement project detailing the measures employed by a network of private practice community pediatricians in Houston, Texas, caring for both insured and uninsured children.


RESULTS
Four categories of interventions were used: enhanced communication, increasing community pediatrician presence, vaccine distribution, and targeted viral diagnosis and antiviral utilization. Promoting communication between clinicians, families, and an affiliated local tertiary care children's hospital allowed for the efficient coordination of resources as well as a unified and consistent message. Increasing access of families to their primary medical home by employing additional clinicians, extending office hours, and locating additional space served to decrease the number of children with low-acuity illness seen in the local emergency centers. Vaccine distribution was enhanced by effective communication between clinicians and families. Finally, targeted antiviral testing and adherence to national recommendations on antiviral utilization enabled judicious utilization of a limited supply of antiviral medications.


CONCLUSIONS
Effective communication and improved access to health care enabled children within the network with influenza-like illnesses to continue to be cared for in their medical home. The measures used in response to novel influenza virus outbreaks can be adapted for other situations requiring increased community surge capacity.
Section of Emergency Medicine, Texas Children's Hospital, Houston, Texas, USA. acruz@bcm.edu
Andrea T
AT
Cruz
Kay O
KO
Tittle
Elizabeth R
ER
Smith
Paul E
PE
Sirbaugh
D000998:Antiviral Agents / Q000600:supply & distribution; D002648:Child; D003142:Communication; D003153:Community Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007252:Influenza Vaccines / Q000600:supply & distribution; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D009819:Office Visits; D058873:Pandemics; D010372:Pediatrics / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D055872:Surge Capacity / Q000458:organization & administration*; D014481:United States
D000998:Antiviral Agents; D007252:Influenza Vaccines