Identifying potential influenza patients in a metropolitan Emergency Department

Ms Jo-anne Mcshane1, Dr Andrew  Maclean1,2, Mrs Leanne Houston4, Mrs Helen Marquand4, Ms Madeleine Smith1, A/Prof Mary O’Reilly2,3

1Emergency Department, Box Hill Hospital, Eastern Health, Box Hill, Australia, 2Eastern Health Clinical School, Monash University Faculty of Medicine, Nursing and Health Sciences, Box Hill, Australia, 3Department of Infectious Diseases, Eastern Health, Victoria Australia, Box Hill, Australia, 4Infection Prevention and Control, Eastern Health, Box Hill, Australia

Aim

The aim of the study was to identify if triage nurses identified potentially infectious influenza like illness (ILI) patients in the Emergency Department (ED) and if correct isolation practices were implemented.

Background

The identification and management of patients with potentially infectious diseases is a challenging aspect of triage. The triage clinician has minutes to decide what may be potentially wrong with a patient and what immediate actions are needed including isolation if required.

Methods

A retrospective e-audit of patients with flu like symptoms data matched with  Polymerase Chain Reaction (PCR) ordering  from the  ED presenting to Box Hill Emergency Department was undertaken from July- September 2016. Data collected: presenting complaint, observations, time to isolation and if Transmission based precautions (TBP) was implemented during their ED visit. Data was entered into Excel and analysed using IBM SPSS v22 .

Results

Data analysis revealed that as expected not all patients with ILI were identified at triage, but also that if ILI was suspected not all patients were isolated appropriately.  Results will be presented including follow-up action taken to address gaps between current performance and best practice.

Conclusion

Triage and primary care nurses in the ED have an opportunity to improve their practise of identifying potential infectious patients by understanding the case definitions for flu, applying surgical masks at triage, and isolating the patient until results of PCR testing are available. Identifying these patients early will help prevent transmission to other, sick vulnerable patients and staff.

Funding

Medtronic Infection Control Scholarship