The Novel H1N1 Outbreak: Lessons Learned

For the Israel Davidson Laboratory of Mount Sinai Hospital, Chicago, IL, the spring 2009 outbreak of H1N1 could have been a catastrophic epidemic. While it was not catastrophic, the lab did process 16% of the positive cases of H1N1 in Cook County—the Illinois county with the largest number of confirmed cases, in the state with the largest number of confirmed cases. The spring outbreak provided valuable lessons for the Sinai lab and other health center laboratories. Long delays for confirmation made cohorting patients difficult, whereas if available, rapid, definitive testing for H1N1 would facilitate patient cohorting and allow workers with non-influenza infections to return to work sooner. Effective communication channels to hospital clinics, as well as the Federally Qualified Health Center (FQHC) clinics served by the lab, was a necessity in light of the continuously changing instructions on specimen collection prescribed by government agencies. Additionally, the changing recommendations about which types of patients should be tested required flexibility on the part of laboratory and hospital personnel. We learned that supply tracing must be detailed, with pediatric supplies tracked separately. Finally, we learned that activating the hospital incident command structure allowed a mechanism for achieving interdepartmental cooperation in order to work through challenging times. Located on the west side of Chicago, Mount Sinai Hospital is a 325 staffed-bed community teaching hospital with 5 residency programs. As a tertiary care center, it serves a population base of 750,000, providing a Level I Trauma Center and Level III Neonatal Intensive Care Center. Its Israel Davidson Laboratory has 94.6 full-time employees (FTEs) and performs 1.65 million billable unit tests per year. Microbiology has 15 FTEs and performs 303,000 billable tests per year. Mount Sinai Hospital is considered a “safety net” hospital in that 60% of its patients are Medicaid, roughly 20% are Medicare, and …