Healthcare Infection Prevention: HHS side of story: Use hotlines, triage

HHS side of story: Use hotlines, triage

But communities must develop own plans

Planning and effective delivery of care in outpatient settings is critical to the nation's pandemic flu preparedness, the Department of Health and Human Services (HHS) states. Though a physician's group recently questioned the adequacy of HHS planning for nonhospital settings, the HHS does have some guidance for outpatient care.

"Appropriate management of outpatient influenza cases will reduce progression to severe disease and thereby reduce demand for inpatient care," the HHS plan states. To decrease the burden on providers and to lessen exposure of the "worried well" to people with influenza, the HHS advises that telephone hotlines should be established to provide advice on whether to stay home or to seek care. "Most persons who seek care can be managed appropriately by outpatient providers," the plan states. "Health care networks may designate specific providers, offices, or clinics for patients with influenza-like illness. Nevertheless, some persons with influenza will likely present to all medical offices and clinics so that planning and preparedness is important at every outpatient care site."

Establish triage at hospitals

In underserved areas, health departments may establish influenza clinics to facilitate access, the plan notes. Hospitals should develop a strategy for triage of potential influenza patients, which may include establishing a site outside of the emergency department where people can be seen initially and identified as needing emergency care or may be referred to an outpatient care site for diagnosis and management. Finally, home health care providers and organizations can provide follow-up for those managed at home, decreasing potential exposure of the public to people who are ill and may transmit infection. Effective management of outpatient care in communities will require that health departments, health care organizations, and providers communicate and plan together. The pandemic plan states that issues to address include:

• establishing and staffing telephone hotlines;
• developing training modules, protocols and algorithms for hotline staff.
• within health care networks, developing plans on the organization of care for influenza patients and develop materials and strategies to inform patients on care-seeking during a pandemic;
• for clinics and offices, developing plans that include education, staffing, triage, infection control in waiting rooms and other areas, and communication with health care partners and public health authorities.

The hospital planning recommendations can serve as a model for planning in other health care settings, including nursing homes and other residential care facilities, and primary care health centers. All health care facilities should:

• create a planning team and develop a written plan;
• establish a decision-making and coordinating structure that can be tested during the interpandemic period and will be activated during an influenza pandemic;
• determine how to conduct surveillance for pandemic influenza in health care personnel and, for residential facilities, in the population served;
• develop policies and procedures for managing pandemic influenza in patients and staff.
• educate and train health care personnel on pandemic influenza and the health care facility's response plan.
• determine how the facility will communicate and coordinate with health care partners and public health authorities during a pandemic.
• determine how the facility will communicate with patients and help educate the public regarding prevention and control measures.
• develop a plan for procuring the supplies (e.g., personal protective equipment [PPE]) needed to manage influenza patients.
• determine how the facility will participate in the community plan for distributing either vaccine or antiviral drugs, including possibly serving as a point of distribution and providing staff for alternative community points of distribution.

If an influenza pandemic causes severe illness in large numbers of people, hospital capacity might be overwhelmed. In that case, communities will need to provide care in alternative sites (e.g., school gymnasiums, armories, convention centers). (Also see www.ahrq.gov/research/altsites.htm.)

(Editor's note: The complete HHS pandemic guidance for nonhospital settings is on the web at: www.hhs.gov/pandemicflu/plan/sup3.html#nonhosp.)