108 Catching the Flu: Influenza Management in the Emergency Department

Abstract

Influenza like illness (ILI) is defined by the World Health Organization as an acute respiratory infection with fever, cough and onset in the last 10 days. Children, especially under the age of 5 years, are at higher risk of severe illness and mortality. Children with underlying medical conditions are identified by the National Advisory Committee on Immunization (NACI) as being high-risk for life threatening complications, and represent more than half of pediatric deaths secondary to influenza. During high acuity seasons, the number of emergency department (ED) visits for ILI increases significantly, representing 10–20% of ED visits. Due to high volumes and acuity of care, adherence to evidence based guidelines can wane. The ED and Infectious Disease teams recognized an opportunity to improve and standardize care for children presenting with ILI. An ILI algorithm was developed in consultation with ED staff, disseminated at ED division meetings and posted in the workstation. A retrospective chart review was used to assess influenza management before and after implementation of the ILI management pathway to assess compliance with evidence based guidelines. All charts (n=2421) for patients presenting to the pediatric ED during peak laboratory confirmed periods of influenza were reviewed both pre (2015–2016) and post (2016–2017) ILI management pathway implementation. Data collected included: demographic data, admission information, comorbid conditions consistent with high-risk criteria, nasopharyngeal swab testing (NPS) and Oseltamivir use. Specific outcomes of interest were appropriate use of NPS testing and timely initiation of antivirals to high-risk patients. During the study periods, 1411 patients presented with ILI to the ED in 2015–2016 versus 1057 in 2016–2017. Overall, the implementation of the ILI management pathway did not influence clinical practice, as there was no significant difference in the identification, admission or treatment of high-risk patients presenting with ILI symptoms. Of the 117 high-risk patients in 2015–2016 and the 114 high-risk patients in 2016–2017 who were admitted to hospital, less than 10% received Oseltamivir each year. Additionally, a similar number of NPS were completed for high-risk and low-risk patients. These findings indicate practice variation from published guidelines on ILI management. Future research is needed to understand physician perspective on ILI management, barriers to implementation and methods to improve knowledge translation to update practice pathways.