Rounding, January/February 2018

How has the heavy flu season impacted operations in your hospital?

CHRISTUS Mother Frances Hospital, Tyler

Increased volume of patients is common during flu season, and our hospital employs operational strategies that can be escalated to meet this increase. We have focused on continually educating our associates, patients and guests about the importance of hand hygiene and vaccination: speaking to them during appointments, through the distribution of posters and signage across the hospitals (and ambulatory facilities), and even by employing social media and public relations tactics to reach the largest possible audience.

Our supply chain teams work closely with the pharmacists, nursing staff, providers and clinical leadership to ensure that we are prepared with adequate levels of supplies and equipment to meet any increased demand. We set up additional hand sanitizer stations and offer surgical masks. When necessary, we open and staff a dedicated surge unit to handle any increased capacity needs by bringing in providers, nurses and associates to provide care. We also have bed huddles to focus on patient flow, sometimes multiple times a day, which allows us to bring all of our clinical team and support services together to plan for additional patient needs.

Cooperation across our organization and throughout our community is also key. We work with our partner LTAC, SNFs, rehab, and home health agencies to discharge patients efficiently in order to ensure excellent care and maximize capacity. We also work with insurance providers proactively so patients can be transferred or directed to the care they need as quickly possible.

Across our Northeast Texas community, we are in constant communication with the other health care providers to manage volumes and help one another ensure that every patient receives excellent, compassionate care – an aim we all share. Though a severe flu season does offer challenges, we have seen truly tireless dedication and hard work from our entire staff. They have taken this opportunity to serve this community and to live out the mission of CHRISTUS Health: to extend the healing ministry of Jesus Christ.

JPS Health Network, Fort Worth

Patient volume in our emergency department hit nearly 400 on two days in early January, which is high but not unheard of. The challenge in this outbreak has been the high acuity level, both in the ED and our urgent care center.

What’s made it manageable is the culture that permeates this hospital and the nimble responsiveness of our senior leadership team in administration. At least half of the ER nurses have been working 60-hour weeks since the holidays. I didn’t even have to ask.

In fact, in times of extreme need like this, I have to make sure we adhere to hospital policy by telling some of our hardest workers that they’ve worked enough and can't come in. Senior leaders were quick to respond to make sure we had the resources to maintain staffing levels and open up beds for patients requiring admission.

In a matter of days, we were able to open a completely new unit with 12 additional beds. Community health carved out part of their space in the family health center to stand up a designated flu clinic — an additional option for non-emergency patients who would otherwise go to the ED or urgent care. Practically overnight, the hospital’s communications team created multi-platform messaging to keep staff informed and help patients find the right care in the right place. That kind of support makes all the difference

Methodist Health Systems, Dallas

The impact of the flu on our hospital has been significant. We are a 500+ bed Level 1 Trauma Center near downtown Dallas. Our emergency department serves as the primary care provider for a large number of patients in our community. Many of these patients have complex medical conditions that put them at an extremely high risk for complications when they contract influenza. This year's flu season has proved to be the most severe in recent memory. It exacerbated chronic and complex medical conditions in many of our patients, and significantly increased utilization of the emergency department at its peak. The increased emergency department utilization occurred over a very short period of time in early January and led to a significant increase in hospital admissions, many to the critical care areas of our hospital.

As a result, bed capacity and staff availability at our hospital was severely strained, but thanks to the flow and staffing improvements implemented earlier in the year, we were able to weather the storm and are beginning to see a light at the end of the tunnel.

Based on our current metrics, the collaborative efforts of our hospital leaders are meeting, and in some cases exceeding, our intended goals for improving patient flow during flu season. Strategies that seem to have created the most positive impact are related to front- and back-end flow improvements in the emergency department.

Front-end improvements include a provider in triage position that relies on a physician starting his or her shift in triage (rather than ending it there); a designated area of the emergency department called "Flu Clinic" where providers can quickly assess and disposition patients with flu-like symptoms based on co-morbidities and vital signs; and "Nurse Driven Protocols" which allow triage nurses to implement "common sense" orders for various chief complaints based on nationally approved quality and safety guidelines when wait times to see a physician or mid-level provider increase.

Back-end improvements include "Interim Admit Orders," which allow our emergency department physicians to enter bed requests and provide basic admit orders (cosigned by a hospitalist) so admitted patients can be moved to the floor when a bed becomes available; "Daily Huddles" attended by nursing and physician directors to more readily address bed-availability issues; and a "Discharge by Noon" policy enacted by our admitting internal medicine colleagues to help free up bed space each day for newly admitted patients.

Also, a notification system following a specific "chain of command" allowed emergency department staff to quickly communicate with hospital administrators when admit holds and boarding hours were reaching nearmaximum levels and starting to impact our ability to care for new patients.

With this real-time information, administrators were able to implement new staffing plans and open up bed space in the hospital to accommodate the increased admit volume from the emergency department. Knowing that our hospital administrators were there to support the emergency department staff during this difficult period really helped boost morale.