Infection Control & Hospital Epidemiology
259
Fig. 1. Influenza-like illness surveillance, North Carolina Emergency Departments, 2017–2018. Near real-time syndromic surveillance for ILI is conducted through the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). This system uses a variety of data sources including emergency departments (EDs). NC DETECT is currently receiving data daily from 126 of the 126 24/7 emergency departments in North Carolina. The NC DETECT ILI syndrome case definition includes any case with the term “flu” or “influenza,” or at least 1 fever term and 1 influenza-related symptom.
these dates did not consider variations in influenza activity in a given year. Using predetermined influenza season dates instead of a data-based approach has the potential to lead to team member masking early in the season when it might not be necessary or to the discontinuation of masking later when influenza activity remains high. Our approach allowed for masking only during times of true increased influenza activity and allowed for extension of the traditional influenza season if warranted. Visitor restrictions, defined as the restriction of visitation to an
acute-care facility by children <13 years of age, was instituted by all healthcare systems when the ILI rate was ≥7% and lifted when the ILI rate returned to <7% (Fig. 1). For the 2017–2018 influenza season, visitor restrictions were initiated on January 12, 2018, and lifted on March 16, 2018. When the ≥7% threshold was reached, a coordinated effort was made between the healthcare systems to provide consistent messaging to team members and the media about who would be restricted from acute-care facilities and when. This was particularly effective for communicating with local media outlets as the media reported the collective decision using a single story.7,8 In years past, multiple media stories would have been published as each system made their decision, leading to mixed public messaging. Likewise, when the level of influenza activity fell to <7%, the media was informed that visitor restric- tions would be lifted. We found that marketing and commu- nication professionals were vital to the success of this process. One additional benefit was noted. In our communities, team
members often work in multiple facilities moving between the different healthcare systems. A unified approach to the influenza season reduced confusion when team members moved between hospitals. Our approach has some limitations. The chosen thresholds for
our decisions were based on clinical judgement and not published research. In addition, the size of some of the healthcare organi- zations meant that a few hospitals were geographically distant. Thus, the ILI rate near those facilities might vary significantly from the other facilities in the collaborative. This distance has led to the consideration of developing additional collaboratives in those areas.
The development of this process was a simple solution that
improved communication between competing healthcare systems, simplified public messaging around influenza season, and stan- dardized influenza season parameters in a single geographic region. The collaboration and exchange of information also increased the congeniality between the healthcare systems, and the participants found it to be informative and enjoyable. We hope that we can apply this approach to additional issues to benefit the communities that we serve.
Acknowledgments. The case data used in this study were provided by the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), an advanced, statewide public health surveillance system. NC DETECT is funded with federal funds by North Carolina Division of Public Health (NC DPH), Public Health Emergency Preparedness Grant (PHEP), and is managed through a collaboration between NC DPH and the University of North Carolina at Chapel Hill Department of Emergency Medicine’s Carolina Center for Health Informatics (UNC CCHI).
Financial support. No financial support was provided relevant to this article.
Conflicts of interest. All authors report no conflicts of interest relevant to this article.
References
1. Prybil LD, Scutchfield FD, Dixon RE. The evolution of public health-hospital collaboration in the United States. Pub Health Rep 2016;131:522–525.
2. Roussos ST, Fawcett SB. A review of collaborative partnerships as a strategy for improving community health. Annu Rev Pub Health 2000;21:369–402.
3. Hardin L, Kilian A, Spykerman K. Competing health care systems and complex patients: an inter-professional collaboration to improve outcomes and reduce health care costs. J Interprof Educ Pract 2017;7:5–10.
4. Ainsworth D, Diaz H, Schmidtlein MC. Getting more for your money: designing community needs assessments to build collaboration and capacity in hospital system community benefit work. Health Promot Pract 2012;14:868–875.
5. United States Census Bureau website.
https://www.census.gov/quickfacts/ nc. Published 2017. Accessed October 2, 2018.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140 |
Page 141 |
Page 142 |
Page 143 |
Page 144 |
Page 145 |
Page 146 |
Page 147 |
Page 148 |
Page 149 |
Page 150 |
Page 151 |
Page 152 |
Page 153 |
Page 154 |
Page 155 |
Page 156
