Was the Pediatric Emergency Department or Pediatric Urgent Care Center Setting More Affected by the Fall 2009 H1N1 Influenza Outbreak?

Abstract

The biphasic H1N1 influenza outbreak of 2009 stressed the limited resources of pediatric emergency departments and primary care practices. Its effect on pediatric urgent care centers has not been described. As a children’s hospital system with both a pediatric emergency department and 2 high-volume pediatric urgent care centers, we sought to learn from our experience how best to allocate resources between these 2 settings to manage children presenting for unscheduled care in future, similar outbreaks. We therefore compared the effects of the fall 2009 phase of the H1N1 influenza outbreak on our pediatric emergency department with its effect on our pediatric urgent care centers. Since the large majority of children who sought care for H1N1 influenza did not require substantial health care resources, we concentrated on comparing the increases in the numbers of patients presenting for care rather than the intensity of their care. We also compared changes in percentages of patients leaving before their evaluations were complete, as a measure of system stress. Since the large majority of pediatric patients affected by H1N1 influenza were only mildly ill and likely appropriate for care in either setting, we hypothesized that both the pediatric emergency department and pediatric urgent care settings were heavily and equally affected.