Skip to main content Accessibility help

Increasing Out-of-Hospital Regional Surge Capacity for H1N1 2009 Influenza A Through Existing Community Pediatrician Offices: A Qualitative Description of Quality Improvement Strategies

  • Andrea T. Cruz, Kay O. Tittle, Elizabeth R. Smith and Paul E. Sirbaugh

Objective: To describe initiatives undertaken by a network of community pediatricians to increase a city's surge capacity for patients presenting with influenza-like illnesses during the 2009 H1N1 influenza A pandemic.

Methods: This was a descriptive quality improvement project detailing the measures employed by a network of private practice community pediatricians in Houston, Texas, caring for both insured and uninsured children.

Results: Four categories of interventions were used: enhanced communication, increasing community pediatrician presence, vaccine distribution, and targeted viral diagnosis and antiviral utilization. Promoting communication between clinicians, families, and an affiliated local tertiary care children's hospital allowed for the efficient coordination of resources as well as a unified and consistent message. Increasing access of families to their primary medical home by employing additional clinicians, extending office hours, and locating additional space served to decrease the number of children with low-acuity illness seen in the local emergency centers. Vaccine distribution was enhanced by effective communication between clinicians and families. Finally, targeted antiviral testing and adherence to national recommendations on antiviral utilization enabled judicious utilization of a limited supply of antiviral medications.

Conclusions: Effective communication and improved access to health care enabled children within the network with influenza-like illnesses to continue to be cared for in their medical home. The measures used in response to novel influenza virus outbreaks can be adapted for other situations requiring increased community surge capacity.

(Disaster Med Public Health Preparedness 2012;6:113-116)

Corresponding author
Correspondence: Andrea T. Cruz, MD, MPH, 6621 Fannin St, Suite A2210, Houston, TX 77030 (e-mail:
Hide All
1.Centers for Disease Control and Prevention (CDC). Surveillance for pediatric deaths associated with 2009 pandemic influenza A (H1N1) virus infection - United States, April-August 2009. MMWR Morb Mortal Wkly Rep. 2009;58 (34):941947.
2.Cruz, AT, Patel, B, DiStefano, MC, et alOutside the box and into thick air: implementation of an exterior mobile pediatric emergency response team for North American H1N1 (Swine) influenza virus in Houston. Texas. Ann Emerg Med. 2010;55(1):2331.
3.United States Census Bureau. Population estimates, 2000-2007. Accessed November 30, 2009.
4.Sirbaugh, PE, Gurwitch, KD, Macias, CG, et alCreation and implementation of a mobile pediatric emergency response team: regional caring for displaced children after a disaster. Pediatrics. 2006;5:S428S438.
5.Advisory Committee on Immunization Practices. Use of influenza A (H1N1) 2009 monovalent vaccine. MMWR Morb Mortal Wkly Rep. 2009;58:18.
6.Cruz, AT, Demmler-Harrison, GJ, Caviness, AC, et alPerformance of a rapid test for diagnosis of H1N1 2009 Influenza A virus in children. Pediatrics. 2010;125:e645e650.
7.Centers for Disease Control and Prevention. Updated interim recommendations for the use of antiviral medications in the treatment and prevention of influenza for the 2009-2010 season (updated October 12, 2009). Accessed December 2, 2009.
8.Barbera, JA, Yeatts, DJ, Macintyre, AG.Challenge of hospital emergency preparedness: analysis and recommendations. Disaster Med Public Health Prep. 2009;3 2(suppl)S74S82.
9.Louie, JK, Acosta, M, Winter, K, et alCalifornia Pandemic (H1N1) Working Group. Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California. JAMA. 2009;302 (17):18961902.
10.Jain, S, Kamimoto, L, Bramley, AM, et al2009 Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med. 2009;361 (20):19351944.
11.Hope-Simpson, RE.Age and secular distributions of virus-proven influenza patients in successive epidemics 1961-1976 in Cirencester: epidemiological significance discussed. J Hyg (Lond). 1984;92 (3):303336.
12.Poehling, KA, Edwards, KM, Weinberg, GA, et alNew Vaccine Surveillance Network. The underrecognized burden of influenza in young children. N Engl J Med. 2006;355 (1):3140.
13.Chiu, SS, Chan, KH, Chen, H, et alVirologically confirmed population-based burden of hospitalization caused by influenza A and B among children in Hong Kong. Clin Infect Dis. 2009;49 (7):10161021.
14.Federico, SG, Steiner, JF, Beaty, B, Crane, L, Kempe, A.Disruptions in insurance coverage: patterns and relationship to health care access, unmet need, and utilization before enrollment in the State Children's Health Insurance Program. Pediatrics. 2007;120 (4):e1009e1016.
15.Zimmer, KP, Walker, A, Minkovitz, CS.Epidemiology of pediatric emergency department use at an urban medical center. Pediatr Emerg Care. 2005;21 (2):8489.
16.Hogg, W, Huston, P, Martin, C, Soto, E.Enhancing public health response to respiratory epidemics: are family physicians ready and willing to help? Can Fam Physician. 2006;52 (10):12541260.
17.Marshall, H, Ryan, P, Roberton, D, Street, J, Watson, M.Pandemic influenza and community preparedness. Am J Public Health. 2009;99(suppl 2)S365S371.
18.Barrett, R, Brown, PJ.Stigma in the time of influenza: social and institutional responses to pandemic emergencies. J Infect Dis. 2008;197(suppl 1)S34S7.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Disaster Medicine and Public Health Preparedness
  • ISSN: 1935-7893
  • EISSN: 1938-744X
  • URL: /core/journals/disaster-medicine-and-public-health-preparedness
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed