H1N1 Surge Triggers Emergency Plan for NYC Hospital

The number of flu cases in New York City ERs jumped 25 percent this Monday. Though many emergency departments said such a "post-weekend bump" in ER visits is common, for one Brooklyn hospital, it was more than just a case of the Mondays.

At Maimonides Hospital in Brooklyn's Sunset Park neighborhood, a surge in pediatric patients over the weekend continued into the week, leading the hospital to trigger its emergency preparedness and surge capacity plan for the first time since it was created this summer.

"[Flu levels] peaked [Tuesday], and over the past five days we're seeing an increase," said Dr. Estevan Garcia, director of pediatric emergency medicine at Maimonides said Wednesday. He added that compared to the same time in 2008, flu cases were up 10 percent.

Monday Spike in ER Patients Common

In tracking the spread of H1N1, the New York City Department of Health has been collecting data on flu visits to the ER from 50 hospitals, a spread that covers 95 percent of ER visits annually for the city.

Though this Monday's surge was the largest increase seen this fall for New York City hospitals, a look back at past health department data showed that Mondays consistently bring a bump in flu patient volume, and often in overall ER patient volume -- a trend that is confirmed anecdotally by ER doctors.

"For us, Mondays are our busiest days [and] I think that happens often for ERs," said Garcia. "[Perhaps] people see how things go for the weekend and then go in on Monday" if it hasn't cleared up.

Dr. Tucker Woods, chairman of emergency medicine at Long Island College Hospital, agreed, saying that "regardless of being in flu season or not, typically Mondays are the busiest days. This is not just [Long Island College Hospital]. This is citywide."

Because of this Monday trend, Eileen Tynion, a spokeswoman for Maimonides Hospital, said that when officials saw an increase in volume for pediatric patients with flu-like symptoms this past weekend, they were not necessarily alarmed. But when the rise in flu cases continued into Tuesday, traditionally the hospital's slowest day, hospital officials became concerned.

Second Wave of H1N1 Arrives in Brooklyn

Maimonides Hospital, the largest tertiary care center for all of Brooklyn, was hit especially hard this spring, Garcia said, and as a result it put together an emergency plan in preparation for another surge in H1N1 flu levels.

"We spent all summer working on it," Garcia said, "anticipating that when school started we would see a surge like the southern states saw."

Garcia said "it's been nice" that the hospital hadn't had to put the plan into effect, but now that flu levels have continued to rise, the hospital has triggered the first phases of the specific surge and emergency preparedness plan set out by its flu task force.

Hospital officials were planning to meet today at 1 p.m. to discuss which aspects of the plan to put into place. Initial steps would be to screen patients for flu symptoms in the waiting room and "cohort" patients into a separate section of the emergency department to minimize the risk of contaminating other patients.

The next step would be to set up a referral center outside the hospital where patients with flu would be "strongly recommended" to go for treatment to reduce the risk of spreading the flu within the hospital.

Considering the hospital houses more births than any other facility in the state and has a large volume of pregnant women and young children, "we are very concerned about spreading H1N1 within the hospital," Tynion said.

In addition, communication efforts may be put into place to reach out to the community and volunteer physicians, and to place ads in the local papers about where to go and what to do if you have the flu.

"Because of the experience in the spring, the hospital has taken a strong stance in how to prepare," Garcia said. "Some ERs have been left to handle [surges] on their own, [but for Maimonides] it's not just an emergency department thing, it's a hospital-wide initiative ... to make sure we're up and ready with what [our patients] need it."