The London medical community is using one of the worst flu seasons in recent memory as a learning experience.
And the lesson may not be over as the London Health Sciences Centre (LHSC) braces itself for the potential of a Norwalk virus pandemic in the Forest City and surrounding counties in the coming weeks.
Also known as the “cruise ship” virus, incidents of the Norwalk virus are cropping up across Canada and in the United States.
“We don’t have flu vaccines for that,” Laurie Gould, LHSC executive vice president of patient care told the hospital’s board of directors Jan. 30. “I’m worried from a patient and staffing perspective. We are formalizing an isolation plan. We are evaluating units we opened in partnership with the two other organizations to see what we learned out of that. We continue to focus on hand hygiene and other strategies to controls infection.”
Gould made the comment as she detailed the response by the facilities of that hospital, St. Joseph’s Health Centre and the Community Care Access Centre (CCAC) to the “worst flu season in recent memory.”
“The impact (of the 2012-13 flu season) is not to be underestimated,” she said. “We learned about our own organization in managing the flu. We are creating a new escalation plan based on that lesson. We need a proactive approach for beds, staffing and supplies.”
During one 12-hour period, the LHSC had to tell Critical Care Ontario they were in “moderate surge” status and could not accept any new patients from other facilities for the first time in the hospital’s 137-year history.
She said a re-think of the LHSC overflow procedure, enacted when the hospital is overwhelmed with new patients and/or backlogged when declared flu outbreaks prevent patients from moving into more appropriate settings (in or out of long-term care facilities, or the emergency department, for example), is in the works.
The key is the flow of alternative level of care (ALC) patients: those occupying desperately needed acute care beds (which most beds in any hospital are classified as) while waiting to transfer to a LTC bed.
At one point LHSC was housing an all-time high of 122 ALC patients.
“Every room in the organization was full,” she said, as the hospital operated between 105 and 113 percent capacity. “This was not an LHSC issue, it was a system problem a city and region problem. That was one of the biggest lessons. Where it showed up was LTC facilities. They couldn’t admit new patients when they had a flu outbreak, so as they shut down, it was a pipe backed up.
“We ended up being the backup.”
The response to the early and intense flu season, which started in September, months sooner than usual, cost the hospital an additional $645,000 in supplies, manpower and additional beds.
The impact on the London health care system intensified in November, when flu patients started being placed in “whatever overflow beds we had,” Gould said. “In December we opened a decant/discharge unit to pull patients out of the emergency department. We partnered with CCAC to boost home care support.”
It wasn’t enough, she said, and “extraordinary” measures were taken. An “incident command centre” to manage the LHSC response to the flu on a day-to-day basis was opened, the number of nurses in the ED was increased and another 21 beds were opened. The LHSC also partnered with St. Jo’s and CCAC to open another 24 beds in the system.
“We all came together to say how do we manage the situation for the region,” Gould said. “So far we have been successful. But the escalation policy was not enough.
Gould said the hospital would not have made it through without their employees, from housekeeping to top-tier management, whom she described as “troopers.” But her concern now is that after all the overtime they logged, cleaners, nurses and doctors are exhausted and becoming increasingly sick themselves.
“There was a significant human resources impact, we logged a tremendous amount of overtime and now employees are tired and starting to get sick. It’s a tremendous concern.”