By Jennifer Decker Arevalo, MA, contributor

Nov. 4. 2009 - Many of the nation’s healthcare facilities have already taken practical steps to handle the escalating number of patients with H1N1 and seasonal flu. Others are considering innovative or more drastic approaches to reduce the potential strain on staff and resources.

How does your flu preparation compare with what other facilities are doing? Take a look at these ideas from around the country to assess your readiness, gain inspiration and shore up areas that could use additional help. (For a quick checklist, see 10 Ways to Prepare for Flu Season)

Start at the top of the list by implementing simple steps, such as creating and posting multilingual signs that inform visitors to notify staff if they have flu-like symptoms. The Centers for Disease Control and Prevention (CDC) has free, printable formats of Cover Your Cough posters in numerous languages for healthcare settings.

Stockpiling extra gloves and surgical masks is another straightforward step. The CDC’s updated H1N1 infection control guidance for healthcare settings recommends that all workers use N-95 respirators—a specific type of face mask that helps to prevent the spread of flu viruses—even though availability may be an issue. Some states, such as California, have made it mandatory.

Another idea comes from Sharp Mary Birch Hospital in San Diego, Calif., which is now using nurses as flu shot “roamers” to distribute vaccinations to employees. Roamers travel throughout the hospital with a vaccination cart; once an announcement has been made over a loudspeaker, employees wishing to receive the H1N1 shot come to the front desk and are quickly inoculated with little disruption to their work.

Roamers are just one way to make the vaccines more accessible to staff. The H1N1 vaccination programs for healthcare workers are generally voluntary and free, but some employers may make it mandatory for safety reasons. The American Nurses Association would only support a mandatory policy if employers followed specific guidelines to ensure that the policy is fair, equitable and not a condition of employment. The American Society of Health-System Pharmacists’ web site, www.YouCanStopTheFlu.com, uses pharmacist advocates to improve flu immunization rates among their fellow healthcare workers.

In addition to stocking up on supplies and immunizing staff, healthcare providers are finding a number of ways to manage capacity and care for patients who have the flu.

A small number of hospitals are experimenting with a drive-through triage area and overflow tents to relieve overcrowding in the emergency department (ED). In June, Stanford Hospital and Clinics in Palo Alto, Calif., conducted the first drive-through triage-and-care system, surge-capacity drill that allowed people with flu symptoms to remain in their cars while healthcare providers treated them through open windows. These patients were kept away from others and had their length of stay cut by 1.5 hours compared to a typical ED visit. This model is quickly gaining acceptance with other hospitals and can be implemented within a day.

The Trust for America’s Health report, H1N1 Challenges Ahead, determined that 15 states could run out of available hospital beds and 12 could exceed 75 percent of their bed capacity, if 35 percent of Americans contract the H1N1 flu virus. Consequently, healthcare facilities are considering ways to manage patient flow to free up hospital beds, possibly by reducing the number of non-flu related discretionary hospitalizations.

In Oklahoma, state health officials plan to cancel elective surgeries, release stable patients, or move patients to other hospitals in the state, if necessary, to free up bed space. They predict that as many as 17,000 Oklahomans with the H1N1 virus could end up in a hospital, filling 57 percent of the state’s hospital beds.

Florida and Utah are considering even more drastic measures to free up beds, such as barring patients with incurable cancer, end-stage multiple sclerosis, or a physician-signed “Do Not Resuscitate” order from being admitted to hospitals flooded with flu cases. Currently, guidelines are being drafted by Florida’s health department to determine who would receive treatment based on clinical scoring systems used to predict survival. In August, Utah conducted a surge-capacity drill to test this plan against realty, unveiling many difficulties that may arise.

“All hospitals have contingency plans for providing extra beds," stated Dale Carrison, DO, FACEP, chairman of the department of emergency medicine at the University of Nevada School of Medicine, in an article for the Las Vegas Review-Journal. "But where do we get the caregivers to care for people? That's the limiting factor in this community."

One way that hospitals are looking to manage medical personnel shortages is by adding more temporary, part-time or on-call staff. Between hospital employees who get sick and are unable to work and the surge in patients with H1N1 and seasonal flu, healthcare facilities are facing a double whammy. Many are turning to staffing companies like AMN Healthcare to inquire about travel nurses and other temporary clinicians.

Some hospitals, like Sharp Chula Vista Medical Center in San Diego, have also used nursing students from local nursing schools to help with flu vaccinations, as “the number of people wanting the vaccine is growing larger than the number of nurse managers available to give it,” according to Sherri Fitzgerald RN, BSN, MSN, MBA, director of acute care and inservice/education.

Finally, some hospitals are taking advantage of the $90 million in Hospital Preparedness grants offered by the U.S. Department of Health and Human Services to enable their facilities to prepare for and respond to outbreaks of the H1N1 virus in local communities. Through it all, American Hospital Association President and CEO Rich Umbdenstock reports in an AHA press release that “hospitals are doing a thorough job of preparing for and handling H1N1 outbreaks in their communities.”

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