Telephone triage of influenza-like illness during pandemic 2009 H1N1 in an obstetric population

doi:10.1016/j.ajog.2012.02.023

American Journal of Obstetrics and Gynecology

Volume 207, Issue 1, July 2012, Pages 3-8

Presented at the 38th annual meeting of the Infectious Disease Society of Obstetrics and Gynecology, Chicago, IL, Aug. 12, 2011.

https://doi.org/10.1016/j.ajog.2012.02.023 Get rights and content

We sought to determine the safety and efficiency of a telephone-based triage system for influenza-like illness, during the 2009 pandemic, at our institution. A triage system was implemented that involved initial telephone screening by a provider who determined whether outpatient telephone-based care or assessment in a centralized evaluation unit was needed. Those who received outpatient care were empirically treated. Those seen in the evaluation unit were assessed for inpatient admission. Of the 230 women who were evaluated, 41% were treated as outpatients and 59% were seen in the evaluation unit. Of those treated as outpatients, 9% were eventually seen in the evaluation unit and only 4% were ultimately admitted, with a maximum hospitalization of 4 days. Of the 135 patients initially seen in the evaluation unit, 32% were admitted and 44% had a positive polymerase chain reaction for respiratory pathogens. This triage system improved efficiency of resource utilization without incurring apparent influenza-like illness morbidity.

Section snippets

Materials and methods

During influenza season 2009 through 2010, physicians at our urban tertiary care medical center were educated regarding influenza and the importance of vaccination. This education occurred via hospital-sponsored physician forums, grand rounds presentations, and literature distribution. In addition to being encouraged to vaccinate all of their pregnant patients, physicians were introduced to a newly developed telephone-based triage system for ILI. At this institution there are 17 practices that

Results

In all, 230 pregnant women were evaluated for ILI from October 2009 through January 2010 (Figure 3). Ninety-five (41%) were treated over the telephone, and 135 (59%) were evaluated and treated in person. Of these 135 women, 120 were seen in the evaluation unit, 13 on labor and delivery, 1 on the postpartum floor, and 1 in the ICU. The women seen on labor and delivery bypassed the triage unit due to concern for labor. The woman seen on the postpartum floor did not develop ILI symptoms until

Comment

The 2009 H1N1 influenza pandemic resulted in increased numbers of evaluations and hospitalizations of pregnant women throughout the United States.⁶ At our own institution, during the peak of the pandemic, >60 pregnant women per week were evaluated for ILI. Such a large number of women who were suddenly in need of additional care, both in the outpatient and inpatient setting, had the potential to overwhelm the resources of health care institutions, and thereby lessen the quality of care of

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Some symptoms indicate severe infection, and therefore should prompt a higher level of care. A triage algorithm to determine whether pregnant women should be evaluated over the phone or in person has been suggested by researchers at Northwestern, and is shown in Fig. 2.29 Similarly, these authors evaluated a triage protocol and criteria for admission, and this process seems to be efficient without increased influenza-related morbidity (Fig. 3).
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: The authors report no conflict of interest.

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Expert reviewObstetrics: Patient safety seriesTelephone triage of influenza-like illness during pandemic 2009 H1N1 in an obstetric population

Section snippets

Materials and methods

Results

Comment

Lancet

Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women

CMAJ

Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women

Am J Epidemiol

Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009

N Engl J Med

Expert review
Obstetrics: Patient safety series
Telephone triage of influenza-like illness during pandemic 2009 H1N1 in an obstetric population