| Perceptions of strain |
“This is the highest influx of flu that was admitted that I’ve seen in probably 10, 12 years. We were really hit hard, and that again put more strains on the resources because they had to be isolated.” “Flu created strain on the entire hospital just because of the sheer volume of patients.” “The NEDOC score and our capacity probably hit the highest that they’ve ever seen in the past 20 years.”
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| Impacts of influenza |
| Staff impact |
“The increased patient volumes ended up becoming a physician capacity issue. Our hospitalist group became overwhelmed with the influx of patients.” “We also see the burnout because then what’s left behind is the nurses who haven’t gotten sick but are trying to pick up for those who are not here.” “When you’re going through that many more, it also affects your EVS staff…and then you don’t have rooms cleaned as fast. And your kitchen staff.”
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| Patient care impact |
“We ended up boarding more patients in our emergency department than we ever had in the past and we had to support staffing to do that…But what would happen if we got to a point where we were so overrun, we would have to slow down our ORs?…So, you would stop doing inpatient surgery on patients that would need beds…like you would have to make very, very hard decisions.” “We were as high as having like 48 people isolated at a time. And we don’t have 48 private rooms. So that means we had to take semiprivates and make them private, which further impacted our ability to do flow.” “It…put a big strain on our isolation supplies and our isolation rooms.”
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| Immediate responses |
| Staffing responses |
“We ended up needing...mandatory overtime. We had staff sign up. We asked everyone to work 1 extra shift per pay period. So that kind of took its toll on staff as well. It wasn’t really a big satisfier, but we needed to do that in order to make sure all the patients were cared for safely.” “We do have a 10-bed overflow unit, and that was open all fall, all winter long to help with increased patient load. We did utilize some temporary staff agency; contractual staff to help meet the need of our increased patient census.”
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| Capacity responses |
“We do have surge plans in place. Do people follow them? No.” “We have a surge plan that we use that changes…during the day. We implemented that a number of times during that period to get discharges out sooner.” “We had our hospital system’s ambulance service...actually taking patients out of the ED...off the floors as well that were ready for discharge.”
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| Future preparedness |
| Staff |
“We’re already hiring travelers and getting everything set up. Like I said, we’re setting up the units. We want to be prepared to deliver that same level of service we expect on the floors. And really you need people to be able to do that so we’re hiring enough temporary help to manage us getting sick and the amount of people that come through our doors that are sick.” “In our lower times we really try and proactively cross train people to a higher level of care and give them the experience that they need so that when the need does arise, we’re prepared for it.”
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| Hospital capacity |
“This last one challenged us where we’ve changed our policies, and that’s where that new capacity management plan came from.” “We haven’t been able to do too much else with bed planning because we pretty much just tapped out everything you could think of as far as areas to go. So we’ll continue to keep brainstorming, but we’ve already tapped into every little place you could think of.” “We have just put together a high census committee and we are working on several action plans...one of those being what we consider overwhelming at the hospital. Just diversion is pretty much like a 4-letter word, and nobody wants to use it. We’re thinking of better ways to go about communicating with EMS and other facilities...So we are actually putting together an action plan now.”
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