title: Pediatric integrated delivery system's experience with pandemic influenza A (H1N1).
abstract: To describe 1 pediatric integrated delivery system's experience with the influenza A (H1N1) pandemic in 2009 to illustrate the benefits of coordination, scale, scope, and flexibility in handling large volumes of patients in many locations.
  
  
  
  Through multidisciplinary planning across a large, multisite pediatric delivery system, an effective 3-tier plan was developed to handle anticipated increased volumes associated with the fall 2009 influenza pandemic in the Philadelphia region.
  
  
  
  Patient demand for services increased to record-setting levels, particularly for emergency department visits and phone calls. The 3-tier plan of response allowed for graded and appropriate response to volumes that more than doubled in many locations. Measured by wait times and leftwithout- being-seen rates, the system appeared to match capacity to demand effectively. Lessons learned in terms of successes and challenges are useful for future planning.
  
  
  
  The experience of 1 pediatric delivery system in handling increased volume due to pandemic influenza may hold lessons for other organizations and for policy makers seeking to improve the preparedness, quality, and value of healthcare. These experiences do not imply the need for vertical integration with ownership, but do support tight coordination, communication, integration, and alignment in any management structure.
authors.affiliation: Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, USA. fieldston@email.chop.edu
authors.forename: Evan S
authors.initials: ES
authors.lastname: Fieldston
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Scarfone
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Biggs
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Zorc
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration; D002648:Child; D003428:Cross Infection / Q000517:prevention & control; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000628:therapy*; D058873:Pandemics; D015143:Philadelphia; D055872:Surge Capacity; D000078329:Workforce