Pandemic Planning and Response in Academic Pediatric Emergency Departments During the 2009 H1N1 Influenza Pandemic
Pandemic Planning and Response in Academic Pediatric Emergency Departments During the 2009 H1N1 Influenza Pandemic
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DOI：
10.1111/acem.12061
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发表时间：
2013-01-01
影响因子：
4.4
通讯作者：
Bogucki, Sandy
中科院分区：
文献类型：
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作者：
Filice, Clara E.;Vaca, Federico E.;Bogucki, Sandy
目标 2001 年 9 月 11 日的恐怖袭击引发了美国向全面或针对所有危险的应急准备框架的转变。此后，H5N1 禽流感的威胁、严重急性呼吸系统综合症流行以及 2009 年 H1N1 流感大流行凸显了在这样的框架内考虑感染事件的重要性。儿科急诊科 (ED) 因 2009 年 H1N1 流感大流行而承受了不成比例的负担，因此可以作为评估大流行防备情况的有力背景。本研究的目的是探讨儿科急诊科领导者在与 H1N1 大流行相关的准备、响应和事件后行动方面的经验，为急诊科未来的大流行和所有危害规划和政策提供信息。方法 作者选择了一种定性设计，非常适合探索复杂、多方面的组织流程，例如规划和应对流行病以及从机构经验中学习。通过有目的的抽样，从代表美国一系列地理区域、医院类型和年度急诊数量的儿科急诊医学培训机构中招募医疗主任或其指定的医师受访者；滚雪球抽样确定了更多信息丰富的受访者。招募工作于 2011 年 5 月开始，一直持续到 2012 年 1 月达到专题饱和为止（n = 20）。数据是通过深入的个人电话采访收集的，并进行录音和专业转录。使用标准访谈指南，向受访者询问有关 H1N1 大流行病相关的大流行病规划、应对和机构学习的开放式问题。数据分析由多学科团队使用扎根理论方法进行，根据受访者表达的观点归纳生成主题。使用不断比较的方法来识别新兴主题。结果 受访者在大流行规划和应对方面的经历有五个共同主题：1）国家大流行性流感防范指南尚未完全渗透到儿科急诊医师（EP）领导层，导致准备状态参差不齐； 2) 与当地公共卫生和其他医疗保健实体保持密切关系的儿科急诊室发现这些关系有利于大流行应对； 3) 儿科急诊领导者报告说很难将公共卫生指导与急诊实践的现实相协调； 4) 尽管许多预期的障碍并未实现，但在某些情况下，儿科 EP 领导者经历了意想不到的制度挑战； 5) 儿科 EP 领导者描述了 H1N1 大流行经历后组织学习的各种经验。结论 尽管在医院准备方面进行了十年的投资，但儿科急诊流行病准备方面的差距仍然存在。这项工作表明，提高对流行病规划标准的认识并推广克服采用这些标准的障碍的策略可以加强急诊室和医院的准备工作。帮助医院更好地应对大流行事件可能会加强对各种灾害的防范。
Objectives The terrorist attacks of September 11, 2001, initiated a shift toward a comprehensive, or all-hazards, framework of emergency preparedness in the United States. Since then, the threat of H5N1 avian influenza, the severe acute respiratory syndrome epidemic, and the 2009 H1N1 influenza pandemic have underscored the importance of considering infectious events within such a framework. Pediatric emergency departments (EDs) were disproportionately burdened by the 2009 H1N1 influenza pandemic and therefore serve as a robust context for evaluation of pandemic preparedness. The objective of this study was to explore pediatric ED leaders' experiences with preparedness, response, and postincident actions related to the H1N1 pandemic to inform future pandemic and all-hazards planning and policy for EDs. Methods The authors selected a qualitative design, well suited for exploring complex, multifaceted organizational processes such as planning for and responding to a pandemic and learning from institutional experiences. Purposeful sampling was used to recruit medical directors or their designated physician respondents from pediatric emergency medicine training institutions representing a range of geographic regions across the United States, hospital types, and annual ED volumes; snowball sampling identified additional information-rich respondents. Recruitment began in May 2011 and continued until thematic saturation was reached in January 2012 (n = 20). Data were collected through in-depth individual phone interviews that were recorded and professionally transcribed. Using a standard interview guide, respondents were asked open-ended questions about pandemic planning, response, and institutional learning related to the H1N1 pandemic. Data analysis was performed by a multidisciplinary team using a grounded theory approach to generate themes inductively from respondents' expressed perspectives. The constant comparative method was used to identify emerging themes. Results Five common themes characterized respondents' experiences with pandemic planning and response: 1) national pandemic influenza preparedness guidance has not fully penetrated to the level of pediatric emergency physician (EP) leaders, leading to variable states of preparedness; 2) pediatric EDs that maintained strong relationships with local public health and other health care entities found those relationships to be beneficial to pandemic response; 3) pediatric EP leaders reported difficulty reconciling public health guidance with the reality of ED practice; 4) although many anticipated obstacles did not materialize, in some cases pediatric EP leaders experienced unexpected institutional challenges; and 5) pediatric EP leaders described varied experiences with organizational learning following the H1N1 pandemic experience. Conclusions Despite a decade of investment in hospital preparedness, gaps in pediatric ED pandemic preparedness remain. This work suggests that raising awareness of pandemic planning standards and promoting strategies to overcome barriers to their adoption could enhance ED and hospital preparedness. Helping hospitals better prepare for pandemic events may lead to strengthened all-hazards preparedness.