Ramping Up For Flu Season: Stanford Redefines its Drive-Through Triage Approach

Dozens of doctors, nurses and volunteers at Stanford Hospital tested out a singular drive-through approach this summer to handle the kind of patient surge the novel H1N1 flu virus could produce this fall.

Emergency medical staff assisting with drive-through triage.
Emergency medical staff prepare to treat patients during an experimental drive-through assessment of the H1N1 flu virus.

During the exercise—the first of its kind in the country—pretend patients remained in their cars, driving through a series of checkpoints in which they were examined by health care workers wearing protective gloves, masks and gowns. The goal was to do a quick and accurate diagnosis of large numbers of people and to control infection in a way that is not possible in a crowded emergency room. It’s part of the hospital’s overall plan to manage a potential H1N1 epidemic locally. 

Though there is much yet to be learned about the virus, “What we do know is that it’s important to maintain social distancing among patients,” said Eric Weiss, MD, the hospital’s medical director for disaster planning. He noted that hospitals need alternatives to long patient waits in emergency rooms where “rapid cross-infection can occur, particularly with airborne disease.”

Keeping track
In the post-drill analysis, the planners pinpointed important changes to be tested in the next practice session this fall. They will have paper forms on hand in case of computer failure, will add more lanes for cars and will designate more workers to talk to waiting motorists about the process and to identify the sickest patients so they can be triaged immediately, among other changes.

The hospital also has established a surge plan to free beds to accommodate more than 100 extra patients, if necessary, said Per Schenk, the hospital’s coordinator of disaster management. Voluntary surgeries, for example, would be delayed, which would open up some preoperative and recovery area spaces.

The hospital is now using a data observation system as an alert, with benchmarks that would trigger the opening of the novel H1N1 unit and the drive-through system, Weiss said. These benchmarks include weekly figures on the number of adults and children arriving with flu-like illnesses at the emergency department and clinics. These figures can be compared to patient volumes during a normal week.

Simple measures
But infection control experts at the hospital say the best flu prevention tactics involve simple behaviors: hand-washing; coughing into a tissue or sleeve, rather than into the hand; and staying away from work for those who have flu-like symptoms.

This year, without a novel H1N1 vaccine widely available, “We have to depend much more on the resolve of people to maintain hand hygiene and cough etiquette,” said Sasha Madison, manager of the hospital’s Infection Control and Epidemiology Department. “If you have a cough, don’t go into large groups of people. Don’t come to work if you have a fever and a cough, sore throat and runny nose.”

She noted that people may be contagious 24 hours before they exhibit symptoms. They should not return to work for seven days if they do develop the flu, according to guidelines of the federal Centers for Disease Control and Prevention.

Mask protection
To help prevent spread of infection, Madison said the hospital may ask patients to wear masks, both for their own protection and the protection of others. Visitors will be offered masks as well, and treatment teams may wear gowns, gloves and masks.

“Masking doesn’t indicate any judgment or have a negative connotation,” she said. “It’s just part of the way in which we protect our patients and our visitors. Wearing a mask needs to become socially acceptable.”

For more information on Stanford’s programs in preparing for H1N1, visit stanfordmedicine.org/flu. You can also learn more about H1N1 and other types of flu at flu.gov.


About Stanford Hospital & Clinics
Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiovascular care, cancer treatment, neurosciences, surgery, and organ transplants. Consistently ranked among the top institutions in the U.S. News & World Report annual list of "America's Best Hospitals," Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. It is part of the Stanford University Medical Center, along with the Stanford University School of Medicine and Lucile Packard Children’s Hospital at Stanford. For more information, visit http://stanfordmedicine.org.

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