ED Weathers Flu Season with Hospital-Wide Support

The difference maker this year was hospital-wide support, pre-planning and teamwork, said Colin Bucks, MD, clinical assistant professor, Emergency Medicine.

“This year has definitely been a noteworthy flu-season,” said Bucks. “But the whole house worked together to get us through it. The hospital supported the ED by letting it use additional space in the ATIC. The Hematology Lab provided a reliable, rapid flu test that dramatically decreased diagnostic time. And the hospital nursing supervisors worked diligently to find inpatient space for patients requiring isolation to prevent in-house transmission.”

“Everyone in the entire hospital helps with the flu season,” said Patrice Callagy, RN, MPA, MSN, CEN, director, Emergency Services. “It’s a well-run operation.”

The 2018 flu season came early, she said, with patient volumes soaring right after Christmas. The ED averaged 241 patients a day from late December through February, with multiple days seeing more than 270 patients. Last year, the ED averaged 200 patients a day during the winter flu surge.

HOC a team approach

Three years ago, Stanford created the Hospital Operations Center (HOC), a group tasked with improving capacity management throughout the hospital. Led by Administrative Director Rudy Arthofer, RN, BSN, the HOC works collaboratively with representatives from the ED, Nursing, Clinical Inpatient Access, the OR and Interventional areas, Environmental Health Services, Case Management, Social Work and hospital leadership.

“The HOC was created when the organization really began to feel the crunch due to increasing demand,” said Arthofer. “We focus a lot on simple workflows, interdepartmental dependencies and predictive analytics to strategize the use of key resources that help support patients moving through the system in a safe, efficient and effective manner. Then we look to future needs and prepare for different scenarios.”

For this year’s flu season, the HOC began planning 12 to 14 months in advance to determine how to flex capacity beyond the hospital’s normal census to handle the additional 50 or more patients admitted from the ED everyday. The ED team conducted its own internal surge planning in September.

The HOC team meets everyday at 8:15 am and then again at 1:45pm. “In those twice-daily meetings, we discuss bottlenecks within the facility that can impact both post-surgical patients and ED patients,” said Gretchen Brown, RN, MSN, RN, NEA-BC, executive director, Patient Care Services, who is responsible for Clinical Inpatient Access. “We talk about different ways to mitigate those bottlenecks.”

In past years, the winter surge was managed on a crisis basis, with multiple ad hoc meetings between the ED and hospital leadership occurring from early morning until late evening.

“We don’t do that anymore,” said Arthofer. “Now we have standard work and everybody knows what to do.” Soaring patient volume and ED admits now trigger a series of scripted, standard workflows that were developed well in advance of the winter surge. For example, when the ED reaches 20 boarding admits, a page goes out to activate alternative care areas, said Callagy.

New Kappa Vertical Unit

With ED patient volume at an all-time high, the HOC developed alternative care areas to get patients seen in the ED more quickly. These areas include hallway beds, a recovery suite in the endoscopy area and a new vertical unit called Kappa in the ATIC (infusion center), down the hall from the ED.

The new Kappa Unit can house up to xx patients vertically in recliners in the afternoons and two full days a week. Securing this space required collaboration between the HOC, Stanford physicians and other infusion centers within the Stanford network to move patients’ infusion appointments to Redwood City or the Neuroscience Health Center.

“With the volume increase, which was nine percent in February, we use Kappa just about everyday,” said Callagy.

Rapid flu test

Processing flu tests more quickly was another area targeted for improvement by the lab team to support the ED. The Core Hematology Lab, which is located down the hall from the ED, was tasked with bringing up and validating a rapid flu test and respiratory panel for use in the ED. In the past, flu A/B and RSV tests were sent to the Hillview Virology Lab, located more than three miles from the hospital. Results could take between four and ten hours. By bringing the testing in-house, results for flu A/B are now available within an hour, and RSV results are ready in four hours.

“The easiest way to provide results more quickly was to use the Core Lab’s machines and validate the flu and RSV kits offered for that machine,” said Jason Kurzer, MD, PhD, medical director for the Hematology Lab. “This was a massive effort from virology and hematology to get equipment validated as quickly as possible.”

The availability of the rapid flu test was immediately utilized. Last year, the Hillview Lab processed about 1,300 rapid flu tests from the ED for the entire year. In just two months of this year’s flu season, the Virology Lab processed 1,412 influenza A/B tests and 668 RSV panels for the ED alone.

“Having the rapid flu test this year was amazing,” said Callagy. “It saved hours and hours of patients waiting in the ED for results.”