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Squeri B, Gayton M, Huang J, Chavez S, Souffront K. Meeting the Challenges of COVID-19: Evaluation of Nurse-Led Changes to Telephonic Assessment. Home Healthc Now 2022; 40:214-222. [PMID: 35777943 DOI: 10.1097/nhh.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The early months of the COVID-19 pandemic caused suspension of physician home visits at our NYC home-based primary care practice as well as disruptions in community-based services homebound patients rely on. This produced gaps in care for a vulnerable patient population that is considered underserved and medically and socially complex. Telephone triage nurses at Mount Sinai Visiting Doctors Program responded to these gaps in care with targeted enhancements to telephonic patient assessment: creating an encrypted email address to receive photographs, the use of two Epic dot phrases to screen and educate regarding COVID-19, assessment of patients' ability to complete a video visit, the reassessment of goals of care, and the assessment of changes in home care services. We surveyed 15 attending physicians in our practice to evaluate primary care providers' opinions regarding changes in nurse telephone triage and how helpful they were in managing patients at home during the early pandemic. We found enhancements to nurse telephone triage were viewed by physicians as beneficial, valuable, and improved patient care. Physicians found changes improved timeliness of care, could improve self-management, helped avoid transfer to emergency department, and helped manage patient care at home. As the pandemic continues and telehealth becomes more widely used, nurse telephone triage may be adaptable to help care for a variety of patient populations during future public health emergencies.
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Sharififar S, Hamidi Farahani R, Khoshvaghti A, Ahmadi Marzaleh M. Designing and Validation of the Nurses' Preparedness to Response to COVID-19 Questionnaire in Iran. Disaster Med Public Health Prep 2021; 16:1-7. [PMID: 34275513 PMCID: PMC8410740 DOI: 10.1017/dmp.2021.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 06/20/2021] [Accepted: 07/04/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Nurses are considered key members to respond to incidents and disasters. As many patients are hospitalized during the coronavirus disease (COVID-19) pandemic, and nurses are directly in contact with these patients; their preparedness enables them to respond to this situation more effectively and protects their health. Therefore, the present study aimed to design and validate a questionnaire to measure the nurses' preparedness in response to COVID-19 in Iran in 2020. METHODS This study was a mixed research aiming to develop and validate a psychometric research instrument in 2020. Based on the review of the literature regarding COVID-19 and other viral respiratory infections, the items were extracted, rewritten, and validated. In the quantitative phase, the validity of the questionnaire was evaluated in terms of face, content, and construct validity, and its reliability was evaluated based on internal consistency and stability (Cronbach's alpha and Intra-class Correlation Coefficient [ICC]). To fill out the questionnaire, the nurses were selected by random sampling. Data analysis was done by the SPSS software, version 23 (IBM Corp, Armonk, NY). RESULTS The designed questionnaire included 9 dimensions and 50 items. The dimensions included (1) Incident Command System (ICS); (2) risk assessment and management; (3) information and communication management; (4) psychological approaches; (5) personal protective equipment; (6) prevention of contamination, isolation, and quarantine; (7) education and training; (8) patient management; and (9) features of the new coronavirus. The content and face validity of the questionnaire were approved by the specialists and experts of nursing and health in disasters and emergencies. The content validity ratio was > 0.7 for all items. The content validity index was also approved for all items. The Cronbach's alpha coefficient and ICC were respectively 0.71 and 0.72 for the total questionnaire. The total score was determined based on 5 ranges, including 50-89 (very low preparedness), 90-129 (low preparedness), 130-170 (medium-level preparedness), 171-210 (high preparedness), and 211-250 (very high preparedness). CONCLUSION Nurses' preparedness to respond to this pandemic requires multilateral measures. Measuring the nurses' preparedness can clarify the challenges in hospital measures taken to respond to this crisis. Evaluating the nurses, determining the challenges and priorities, and finding solutions to resolve them can improve the nurses' performance in providing health care services. Preparation of nurses during pandemics can reduce the damages to this group and maximize their efforts to protect the patients. Thus, health planners and policy-makers should try to promote the nurses' awareness and preparedness.
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Affiliation(s)
- Simintaj Sharififar
- Department of Health in Disasters and Emergencies, Nursing Faculty of AJA University of Medical Sciences, Tehran, Iran
| | - Ramin Hamidi Farahani
- Department of Infectious Diseases, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Amir Khoshvaghti
- Aerospace Medicine Research Center, Aerospace and Subaquatic Medicine Faculty, AJA University of Medical Sciences, Tehran, Iran
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
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Koonin LM, Sliger K, Kerr J, Bullen-Austin L, Graeden E, Farris K, Ionta C, Krause D, Patel A. CDC's Flu on Call Simulation: Testing a National Helpline for Use During an Influenza Pandemic. Health Secur 2021; 18:392-402. [PMID: 33107763 DOI: 10.1089/hs.2019.0152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
During an influenza pandemic, healthcare facilities are likely to be filled to capacity, leading to delays in seeing a provider and obtaining treatment. Flu on Call is a collaborative effort between the US Centers for Disease Control and Prevention and partners to develop a toll-free telephone helpline to reduce the burden on healthcare facilities and improve access to antivirals for people who are ill during an influenza pandemic. This study tested the feasibility of Flu on Call during a 1-day simulation using a severe pandemic scenario. Trained volunteer actors placed calls to the helpline using prepared scripts that were precoded for an expected outcome ("disposition") of the call. Scripts represented callers who were ill, those calling for someone else who was ill, and callers who were only seeking information. Information specialists and medical professionals managed the calls. Results demonstrated that Flu on Call may effectively assist callers during a pandemic, increase access to antiviral prescriptions, and direct patients to the appropriate level of care. Overall, 84% of calls exactly matched the expected call disposition; few calls (2%) were undermanaged (eg, the caller was ill but not transferred to a medical professional or received advice from the medical professional that was less intensive than what was warranted). Callers indicated a high level of satisfaction (83% reported their needs were met). Because of the high volume of calls that may be received during a severe pandemic, the Flu on Call platform should evolve to include additional triage channels (eg, through internet, chat, and/or text access).
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Affiliation(s)
- Lisa M Koonin
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Kellye Sliger
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Justin Kerr
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Lisa Bullen-Austin
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Ellie Graeden
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Kevin Farris
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Christopher Ionta
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Diane Krause
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
| | - Anita Patel
- Lisa M. Koonin, DrPH, MN, MPH, was Deputy Director at the time this study was conducted; and Anita Patel, PharmD, MS, is Senior Advisor, Pandemic Medical Care and Countermeasures Lead; both in the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA. Kellye Sliger, MPH, is an Epidemiologist; Kevin Farris, MAEd, is Health Communication, Preparedness, and Training Manager; and Diane Krause, MS-MPH is a Health Education Specialist; all at Oak Ridge Associated Universities, Oak Ridge, TN. Justin Kerr, PhD, is Head of Research; and Ellie Graeden, PhD, is Chief Executive Officer; both at Talus Analytics, Boulder, CO. Lisa Bullen-Austin is Senior Vice President, Vigilant Watch Integration Inc, Stafford, VA. Christopher Ionta is Senior Business Process Analyst with SRA International/CSRA, Inc., Atlanta, GA
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Jensen T, Holgersen MG, Jespersen MS, Blomberg SN, Folke F, Lippert F, Christensen HC. Strategies to Handle Increased Demand in the COVID-19 Crisis: A Coronavirus EMS Support Track and a Web-Based Self-Triage System. PREHOSP EMERG CARE 2020; 25:28-38. [PMID: 32870754 DOI: 10.1080/10903127.2020.1817212] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In emergencies, such as the COVID-19 pandemic, there is an increased need for contact with emergency medical services (EMS), and call volume might surpass capacity. The Copenhagen EMS operates two telephone line the 1-1-2 emergency number and the 1813 medical helpline. A separate coronavirus support track was implemented on the 1813 medical helpline and a web-based self-triage (web triage) system was created to reduce non-emergency call volume. The aim of this paper is to present call volume and the two measures implemented to handle the increased call volume to the Copenhagen EMS. METHODS This is a cross sectional observational study. Call volume and queue time is presented in the first month of the COVID-19 pandemic (27th of February 2020 to 27th of march) and compared to the equivalent month from the year before (2019). Descriptive statistics are conducted on call volumes and queue times and spearman's rank correlation test are performed to test correlation between web triage and call volume. RESULTS Total EMS call volume increase by 23.3% between 2019 and 2020 (92.670 vs. 114,250). The 1-1-2 emergency line total call volume increase by 4.4% (8,4942 vs. 8,870) and the 1813 medical helpline increased by 25.1% (84.176 vs. 105.380). The coronavirus support track handled 21,063 calls. The 1813 medical helpline queue time was a mean of 02 minutes and 23 seconds (CI: 2.22-2.25) in 2019 and 12 minutes and 2 seconds (CI 11:55-12:09) in 2020 (P < 0.001). The web triage was used 10,894 times. No correlation between call volume and web triage usage was seen. CONCLUSIONS In the first month of the ongoing COVID-19 pandemic a significant increase in call volume was observed in the 1813 medical helpline compared to 2019. A large number of calls were handled by the additional coronavirus track and diverted away from the regular tracks of the 1813 medical helpline. This likely contributed to mitigating increased call volumes and queue times. The web triage was widely used but no significant correlation was seen with 1813 medical helpline call volume. Other EMS organizations can learn from this to enhance capacity in a future epidemics.
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Medical Student Mobilization During a Pandemic: The Ochsner Clinical School Response to COVID-19. Ochsner J 2020; 20:146-150. [PMID: 32612468 PMCID: PMC7310173 DOI: 10.31486/toj.20.0069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Patel A, Lee L, Pillai SK, Valderrama AL, Delaney LJ, Radonovich L. Approach to Prioritizing Respiratory Protection When Demand Exceeds Supplies During an Influenza Pandemic: A Call to Action. Health Secur 2019; 17:152-155. [PMID: 31009256 DOI: 10.1089/hs.2019.0027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Anita Patel
- Anita Patel, PharmD, MS, is Senior Advisor, Medical Care and Countermeasures Lead, Influenza Coordination Unit; and Leslie Lee, MPH, is a Public Health Advisor, General Dynamics Information Technology, contracted to the Influenza Coordination Unit; both in the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish K. Pillai, MD, MPH, is Deputy Director, Division of Preparedness and Emerging Infectious Disease; and Amy L. Valderrama, PhD, RN, is a Nurse Epidemiologist, Division of Healthcare Quality Promotion; both in the National Center for Emerging and Zoonotic Infections Diseases, CDC, Atlanta, GA. Lisa J. Delaney, MS, is Associate Director for Emergency Preparedness and Response, National Institute for Occupational Safety and Health (NIOSH), CDC, Atlanta, GA. Lewis Radonovich, MD, is Chief of Research, National Personal Protective Technology Laboratory, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Leslie Lee
- Anita Patel, PharmD, MS, is Senior Advisor, Medical Care and Countermeasures Lead, Influenza Coordination Unit; and Leslie Lee, MPH, is a Public Health Advisor, General Dynamics Information Technology, contracted to the Influenza Coordination Unit; both in the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish K. Pillai, MD, MPH, is Deputy Director, Division of Preparedness and Emerging Infectious Disease; and Amy L. Valderrama, PhD, RN, is a Nurse Epidemiologist, Division of Healthcare Quality Promotion; both in the National Center for Emerging and Zoonotic Infections Diseases, CDC, Atlanta, GA. Lisa J. Delaney, MS, is Associate Director for Emergency Preparedness and Response, National Institute for Occupational Safety and Health (NIOSH), CDC, Atlanta, GA. Lewis Radonovich, MD, is Chief of Research, National Personal Protective Technology Laboratory, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Satish K Pillai
- Anita Patel, PharmD, MS, is Senior Advisor, Medical Care and Countermeasures Lead, Influenza Coordination Unit; and Leslie Lee, MPH, is a Public Health Advisor, General Dynamics Information Technology, contracted to the Influenza Coordination Unit; both in the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish K. Pillai, MD, MPH, is Deputy Director, Division of Preparedness and Emerging Infectious Disease; and Amy L. Valderrama, PhD, RN, is a Nurse Epidemiologist, Division of Healthcare Quality Promotion; both in the National Center for Emerging and Zoonotic Infections Diseases, CDC, Atlanta, GA. Lisa J. Delaney, MS, is Associate Director for Emergency Preparedness and Response, National Institute for Occupational Safety and Health (NIOSH), CDC, Atlanta, GA. Lewis Radonovich, MD, is Chief of Research, National Personal Protective Technology Laboratory, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Amy L Valderrama
- Anita Patel, PharmD, MS, is Senior Advisor, Medical Care and Countermeasures Lead, Influenza Coordination Unit; and Leslie Lee, MPH, is a Public Health Advisor, General Dynamics Information Technology, contracted to the Influenza Coordination Unit; both in the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish K. Pillai, MD, MPH, is Deputy Director, Division of Preparedness and Emerging Infectious Disease; and Amy L. Valderrama, PhD, RN, is a Nurse Epidemiologist, Division of Healthcare Quality Promotion; both in the National Center for Emerging and Zoonotic Infections Diseases, CDC, Atlanta, GA. Lisa J. Delaney, MS, is Associate Director for Emergency Preparedness and Response, National Institute for Occupational Safety and Health (NIOSH), CDC, Atlanta, GA. Lewis Radonovich, MD, is Chief of Research, National Personal Protective Technology Laboratory, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Lisa J Delaney
- Anita Patel, PharmD, MS, is Senior Advisor, Medical Care and Countermeasures Lead, Influenza Coordination Unit; and Leslie Lee, MPH, is a Public Health Advisor, General Dynamics Information Technology, contracted to the Influenza Coordination Unit; both in the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish K. Pillai, MD, MPH, is Deputy Director, Division of Preparedness and Emerging Infectious Disease; and Amy L. Valderrama, PhD, RN, is a Nurse Epidemiologist, Division of Healthcare Quality Promotion; both in the National Center for Emerging and Zoonotic Infections Diseases, CDC, Atlanta, GA. Lisa J. Delaney, MS, is Associate Director for Emergency Preparedness and Response, National Institute for Occupational Safety and Health (NIOSH), CDC, Atlanta, GA. Lewis Radonovich, MD, is Chief of Research, National Personal Protective Technology Laboratory, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Lewis Radonovich
- Anita Patel, PharmD, MS, is Senior Advisor, Medical Care and Countermeasures Lead, Influenza Coordination Unit; and Leslie Lee, MPH, is a Public Health Advisor, General Dynamics Information Technology, contracted to the Influenza Coordination Unit; both in the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Satish K. Pillai, MD, MPH, is Deputy Director, Division of Preparedness and Emerging Infectious Disease; and Amy L. Valderrama, PhD, RN, is a Nurse Epidemiologist, Division of Healthcare Quality Promotion; both in the National Center for Emerging and Zoonotic Infections Diseases, CDC, Atlanta, GA. Lisa J. Delaney, MS, is Associate Director for Emergency Preparedness and Response, National Institute for Occupational Safety and Health (NIOSH), CDC, Atlanta, GA. Lewis Radonovich, MD, is Chief of Research, National Personal Protective Technology Laboratory, NIOSH, CDC, Pittsburgh, PA. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
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Adhikari BB, Koonin LM, Mugambi ML, Sliger KD, Washington ML, Kahn EB, Meltzer MI. Estimating Weekly Call Volume to a National Nurse Telephone Triage Line in an Influenza Pandemic. Health Secur 2019; 16:334-340. [PMID: 30339099 DOI: 10.1089/hs.2018.0061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Telephone nurse triage lines, such as the Centers for Disease Control and Prevention's (CDC) Flu on Call®, a national nurse triage line, may help reduce the surge in demand for health care during an influenza pandemic by triaging callers, providing advice about clinical care and information about the pandemic, and providing access to prescription antiviral medication. We developed a Call Volume Projection Tool to estimate national call volume to Flu on Call® during an influenza pandemic. The tool incorporates 2 influenza clinical attack rates (20% and 30%), 4 different levels of pandemic severity, and different initial "seed numbers" of cases (10 or 100), and it allows variation in which week the nurse triage line opens. The tool calculates call volume by using call-to-hospitalization ratios based on pandemic severity. We derived data on nurse triage line calls and call-to-hospitalization ratios from experience with the 2009 Minnesota FluLine nurse triage line. Assuming a 20% clinical attack rate and a case hospitalization rate of 0.8% to 1.5% (1968-like pandemic severity), we estimated the nationwide number of calls during the peak week of the pandemic to range from 1,551,882 to 3,523,902. Assuming a more severe 1957-like pandemic (case hospitalization rate = 1.5% to 3.0%), the national number of calls during the peak week of the pandemic ranged from 2,909,778 to 7,047,804. These results will aid in planning and developing nurse triage lines at both the national and state levels for use during a future influenza pandemic.
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Affiliation(s)
- Bishwa B Adhikari
- Bishwa B. Adhikari, PhD, is a Senior Economist; Michael L. Washington, PhD, is a Health Scientist; Emily B. Kahn, PhD, is a Senior Epidemiologist; and Martin I. Meltzer, PhD, is Senior Health Economist/Distinguished Consultant; all at the National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Lisa M. Koonin, DrPH, MN, MPH, is Deputy Director, Influenza Coordination Unit, National Center for Immunization & Respiratory Diseases, CDC, Atlanta. Melissa L. Mugambi, PhD, is Assistant Professor, Department of Global Health, University of Washington , Seattle, WA. Kellye D. Sliger, MPH, is an Epidemiologist, Oak Ridge Associated Universities, Oak Ridge, TN. The authors are solely responsible for the content of this article; the views presented do not necessarily represent the official views of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Lisa M Koonin
- Bishwa B. Adhikari, PhD, is a Senior Economist; Michael L. Washington, PhD, is a Health Scientist; Emily B. Kahn, PhD, is a Senior Epidemiologist; and Martin I. Meltzer, PhD, is Senior Health Economist/Distinguished Consultant; all at the National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Lisa M. Koonin, DrPH, MN, MPH, is Deputy Director, Influenza Coordination Unit, National Center for Immunization & Respiratory Diseases, CDC, Atlanta. Melissa L. Mugambi, PhD, is Assistant Professor, Department of Global Health, University of Washington , Seattle, WA. Kellye D. Sliger, MPH, is an Epidemiologist, Oak Ridge Associated Universities, Oak Ridge, TN. The authors are solely responsible for the content of this article; the views presented do not necessarily represent the official views of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Melissa L Mugambi
- Bishwa B. Adhikari, PhD, is a Senior Economist; Michael L. Washington, PhD, is a Health Scientist; Emily B. Kahn, PhD, is a Senior Epidemiologist; and Martin I. Meltzer, PhD, is Senior Health Economist/Distinguished Consultant; all at the National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Lisa M. Koonin, DrPH, MN, MPH, is Deputy Director, Influenza Coordination Unit, National Center for Immunization & Respiratory Diseases, CDC, Atlanta. Melissa L. Mugambi, PhD, is Assistant Professor, Department of Global Health, University of Washington , Seattle, WA. Kellye D. Sliger, MPH, is an Epidemiologist, Oak Ridge Associated Universities, Oak Ridge, TN. The authors are solely responsible for the content of this article; the views presented do not necessarily represent the official views of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Kellye D Sliger
- Bishwa B. Adhikari, PhD, is a Senior Economist; Michael L. Washington, PhD, is a Health Scientist; Emily B. Kahn, PhD, is a Senior Epidemiologist; and Martin I. Meltzer, PhD, is Senior Health Economist/Distinguished Consultant; all at the National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Lisa M. Koonin, DrPH, MN, MPH, is Deputy Director, Influenza Coordination Unit, National Center for Immunization & Respiratory Diseases, CDC, Atlanta. Melissa L. Mugambi, PhD, is Assistant Professor, Department of Global Health, University of Washington , Seattle, WA. Kellye D. Sliger, MPH, is an Epidemiologist, Oak Ridge Associated Universities, Oak Ridge, TN. The authors are solely responsible for the content of this article; the views presented do not necessarily represent the official views of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Michael L Washington
- Bishwa B. Adhikari, PhD, is a Senior Economist; Michael L. Washington, PhD, is a Health Scientist; Emily B. Kahn, PhD, is a Senior Epidemiologist; and Martin I. Meltzer, PhD, is Senior Health Economist/Distinguished Consultant; all at the National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Lisa M. Koonin, DrPH, MN, MPH, is Deputy Director, Influenza Coordination Unit, National Center for Immunization & Respiratory Diseases, CDC, Atlanta. Melissa L. Mugambi, PhD, is Assistant Professor, Department of Global Health, University of Washington , Seattle, WA. Kellye D. Sliger, MPH, is an Epidemiologist, Oak Ridge Associated Universities, Oak Ridge, TN. The authors are solely responsible for the content of this article; the views presented do not necessarily represent the official views of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Emily B Kahn
- Bishwa B. Adhikari, PhD, is a Senior Economist; Michael L. Washington, PhD, is a Health Scientist; Emily B. Kahn, PhD, is a Senior Epidemiologist; and Martin I. Meltzer, PhD, is Senior Health Economist/Distinguished Consultant; all at the National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Lisa M. Koonin, DrPH, MN, MPH, is Deputy Director, Influenza Coordination Unit, National Center for Immunization & Respiratory Diseases, CDC, Atlanta. Melissa L. Mugambi, PhD, is Assistant Professor, Department of Global Health, University of Washington , Seattle, WA. Kellye D. Sliger, MPH, is an Epidemiologist, Oak Ridge Associated Universities, Oak Ridge, TN. The authors are solely responsible for the content of this article; the views presented do not necessarily represent the official views of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
| | - Martin I Meltzer
- Bishwa B. Adhikari, PhD, is a Senior Economist; Michael L. Washington, PhD, is a Health Scientist; Emily B. Kahn, PhD, is a Senior Epidemiologist; and Martin I. Meltzer, PhD, is Senior Health Economist/Distinguished Consultant; all at the National Center for Emerging & Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Lisa M. Koonin, DrPH, MN, MPH, is Deputy Director, Influenza Coordination Unit, National Center for Immunization & Respiratory Diseases, CDC, Atlanta. Melissa L. Mugambi, PhD, is Assistant Professor, Department of Global Health, University of Washington , Seattle, WA. Kellye D. Sliger, MPH, is an Epidemiologist, Oak Ridge Associated Universities, Oak Ridge, TN. The authors are solely responsible for the content of this article; the views presented do not necessarily represent the official views of the Centers for Disease Control and Prevention. The authors have no conflicts of interest
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Jester BJ, Uyeki TM, Patel A, Koonin L, Jernigan DB. 100 Years of Medical Countermeasures and Pandemic Influenza Preparedness. Am J Public Health 2018; 108:1469-1472. [PMID: 30252525 PMCID: PMC6187768 DOI: 10.2105/ajph.2018.304586] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2018] [Indexed: 11/04/2022]
Abstract
The 1918 influenza pandemic spread rapidly around the globe, leading to high mortality and social disruption. The countermeasures available to mitigate the pandemic were limited and relied on nonpharmaceutical interventions. Over the past 100 years, improvements in medical care, influenza vaccines, antiviral medications, community mitigation efforts, diagnosis, and communications have improved pandemic response. A number of gaps remain, including vaccines that are more rapidly manufactured, antiviral drugs that are more effective and available, and better respiratory protective devices.
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Affiliation(s)
- Barbara J Jester
- Barbara J. Jester is a Battelle contractor working for the Influenza Division at Centers for Disease Control and Prevention (CDC), Atlanta, GA. Timothy M. Uyeki is chief medical officer for the Influenza Division at CDC. Anita Patel is the medical care and countermeasures team lead for the Influenza Coordination Unit at CDC. Lisa Koonin is deputy director of the Influenza Coordination Unit at CDC. Daniel B. Jernigan is director of the Influenza Division at CDC
| | - Timothy M Uyeki
- Barbara J. Jester is a Battelle contractor working for the Influenza Division at Centers for Disease Control and Prevention (CDC), Atlanta, GA. Timothy M. Uyeki is chief medical officer for the Influenza Division at CDC. Anita Patel is the medical care and countermeasures team lead for the Influenza Coordination Unit at CDC. Lisa Koonin is deputy director of the Influenza Coordination Unit at CDC. Daniel B. Jernigan is director of the Influenza Division at CDC
| | - Anita Patel
- Barbara J. Jester is a Battelle contractor working for the Influenza Division at Centers for Disease Control and Prevention (CDC), Atlanta, GA. Timothy M. Uyeki is chief medical officer for the Influenza Division at CDC. Anita Patel is the medical care and countermeasures team lead for the Influenza Coordination Unit at CDC. Lisa Koonin is deputy director of the Influenza Coordination Unit at CDC. Daniel B. Jernigan is director of the Influenza Division at CDC
| | - Lisa Koonin
- Barbara J. Jester is a Battelle contractor working for the Influenza Division at Centers for Disease Control and Prevention (CDC), Atlanta, GA. Timothy M. Uyeki is chief medical officer for the Influenza Division at CDC. Anita Patel is the medical care and countermeasures team lead for the Influenza Coordination Unit at CDC. Lisa Koonin is deputy director of the Influenza Coordination Unit at CDC. Daniel B. Jernigan is director of the Influenza Division at CDC
| | - Daniel B Jernigan
- Barbara J. Jester is a Battelle contractor working for the Influenza Division at Centers for Disease Control and Prevention (CDC), Atlanta, GA. Timothy M. Uyeki is chief medical officer for the Influenza Division at CDC. Anita Patel is the medical care and countermeasures team lead for the Influenza Coordination Unit at CDC. Lisa Koonin is deputy director of the Influenza Coordination Unit at CDC. Daniel B. Jernigan is director of the Influenza Division at CDC
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Koonin LM, Patel A. Timely Antiviral Administration During an Influenza Pandemic: Key Components. Am J Public Health 2018; 108:S215-S220. [PMID: 30192657 PMCID: PMC6129661 DOI: 10.2105/ajph.2018.304609] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 11/04/2022]
Abstract
Prompt treatment of ill persons with influenza antivirals will be an important part of a future pandemic influenza response. This essay reviews key lessons learned from the 2009 H1N1 pandemic and the changing landscape of antiviral drug availability, and identifies and describes the multiple components needed to ensure the timely administration of antiviral drugs during a future pandemic. Fortunately, many of these planning efforts can take place before a pandemic strikes to improve outcomes during a future public health emergency.
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Affiliation(s)
- Lisa M Koonin
- Both authors are with the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Anita Patel
- Both authors are with the Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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Zaza S, Koonin LM, Ajao A, Nystrom SV, Branson R, Patel A, Bray B, Iademarco MF. A Conceptual Framework for Allocation of Federally Stockpiled Ventilators During Large-Scale Public Health Emergencies. Health Secur 2016; 14:1-6. [DOI: 10.1089/hs.2015.0043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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O'Hagan JJ, Wong KK, Campbell AP, Patel A, Swerdlow DL, Fry AM, Koonin LM, Meltzer MI. Estimating the United States demand for influenza antivirals and the effect on severe influenza disease during a potential pandemic. Clin Infect Dis 2015; 60 Suppl 1:S30-41. [PMID: 25878299 DOI: 10.1093/cid/civ084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Following the detection of a novel influenza strain A(H7N9), we modeled the use of antiviral treatment in the United States to mitigate severe disease across a range of hypothetical pandemic scenarios. Our outcomes were total demand for antiviral (neuraminidase inhibitor) treatment and the number of hospitalizations and deaths averted. The model included estimates of attack rate, healthcare-seeking behavior, prescription rates, adherence, disease severity, and the potential effect of antivirals on the risks of hospitalization and death. Based on these inputs, the total antiviral regimens estimated to be available in the United States (as of April 2013) were sufficient to meet treatment needs for the scenarios considered. However, distribution logistics were not examined and should be addressed in future work. Treatment was estimated to avert many severe outcomes (5200-248,000 deaths; 4800-504,000 hospitalizations); however, large numbers remained (25,000-425,000 deaths; 580,000-3,700,000 hospitalizations), suggesting that the impact of combinations of interventions should be examined.
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Affiliation(s)
- Justin J O'Hagan
- National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC) IHRC Inc
| | - Karen K Wong
- Epidemic Intelligence Service assigned to Influenza Division
| | | | | | - David L Swerdlow
- National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC) Modeling Unit and Office of the Director, NCIRD
| | - Alicia M Fry
- Epidemiology and Prevention Branch, Influenza Division, NCIRD
| | - Lisa M Koonin
- Influenza Coordination Unit, Office of Infectious Diseases
| | - Martin I Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, Georgia
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Hick JL, Einav S, Hanfling D, Kissoon N, Dichter JR, Devereaux AV, Christian MD. Surge capacity principles: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest 2015; 146:e1S-e16S. [PMID: 25144334 DOI: 10.1378/chest.14-0733] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This article provides consensus suggestions for expanding critical care surge capacity and extension of critical care service capabilities in disasters or pandemics. It focuses on the principles and frameworks for expansion of intensive care services in hospitals in the developed world. A companion article addresses surge logistics, those elements that provide the capability to deliver mass critical care in disaster events. The suggestions in this article are important for all who are involved in large-scale disasters or pandemics with injured or critically ill multiple patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS The Surge Capacity topic panel developed 23 key questions focused on the following domains: systems issues; equipment, supplies, and pharmaceuticals; staffing; and informatics. Literature searches were conducted to identify evidence on which to base key suggestions. Most reports were small scale, were observational, or used flawed modeling; hence, the level of evidence on which to base recommendations was poor and did not permit the development of evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions from the previous task force were also included for validation by the expert panel. RESULTS This article presents 10 suggestions pertaining to the principles that should guide surge capacity and capability planning for mass critical care, including the role of critical care in disaster planning; the surge continuum; targets of surge response; situational awareness and information sharing; mitigating the impact on critical care; planning for the care of special populations; and service deescalation/cessation (also considered as engineered failure). CONCLUSIONS Future reports on critical care surge should emphasize population-based outcomes as well as logistical details. Planning should be based on the projected number of critically ill or injured patients resulting from specific scenarios. This should include a consideration of ICU patient care requirements over time and must factor in resource constraints that may limit the ability to provide care. Standard ICU management forms and patient data forms to assess ICU surge capacity impacts should be created and used in disaster events.
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Fain BA, Koonin LM, Stoto MA, Shah UA, Cooper SR, Piltch-Loeb RN, Kellermann AL. Facilitating access to antiviral medications and information during an influenza pandemic: engaging with the public on possible new strategies. Biosecur Bioterror 2014; 12:8-19. [PMID: 24552360 DOI: 10.1089/bsp.2013.0058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Antiviral medications can decrease the severity and duration of influenza, but they are most effective if started within 48 hours of the onset of symptoms. In a severe influenza pandemic, normal channels of obtaining prescriptions and medications could become overwhelmed. To assess public perception of the acceptability and feasibility of alternative strategies for prescribing, distributing, and dispensing antivirals and disseminating information about influenza and its treatment, the Institute of Medicine, with technical assistance from the Centers for Disease Control and Prevention (CDC), convened public engagement events in 3 demographically and geographically diverse communities: Fort Benton, MT; Chattanooga, TN; and Los Angeles, CA. Participants were introduced to the issues associated with pandemic influenza and the challenges of ensuring timely public access to information and medications. They then discussed the advantages and disadvantages of 5 alternative strategies currently being considered by the CDC and its partners. Participants at all 3 venues expressed high levels of acceptance for each of the proposed strategies and contributed useful ideas to support their implementation. This article discusses the key findings from these sessions.
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