As reported by The Hartford Courant, October 2, 2009.

State Hospitals Making Preparations for Possible Swine Flu Pandemic

By Arielle Levin Becker

If swine flu hits hard, a trip to the hospital in the coming months could look very different from how it would look today.

For one thing, elective surgeries would probably be put off, with recovery room space converted to patient beds. Patients with less severe illnesses might be sent home with arrangements to get care there. Because some hospital workers might be home sick themselves, the people from payroll might be delivering food. And if you're not that sick, you might find yourself at a newly created off-site clinic, not in the hospital at all.

Depending on how widespread and how severe it becomes, a swine flu pandemic could pose challenges that hospitals have rarely, if ever, seen. So far, hospital officials say, the illness has largely been an outpatient issue, something that most patients can recover from without even visiting the doctor. But they have plans in case it gets worse.

A report released Thursday suggests that those plans could be especially important for Connecticut hospitals.

Using a model developed by the federal Centers for Disease Control and Prevention, the Trust for America's Health examined what would happen if 35 percent of the population got H1N1 flu. It found that 15 states would run out of available hospital beds. Connecticut hospitals could be 48 percent above capacity, the second-highest rate in the nation, behind Delaware, which the report said could face demand more than twice its capacity.

The report studied the number of existing hospital beds and did not take into account plans to address a surge in patients. By state law hospitals are required to have disaster plans.

Leonard Guercia Jr., chief of operations at the state Department of Public Health, said that hospital and state preparedness efforts since 9/11 have made the state hospitals better able to adapt to an increased demand for care.

"I'm very confident," Guercia said.

The report projected that Connecticut could have 17,305 hospital admissions in a flu pandemic, far more than the 6,688 inpatient beds hospitals operated in the 2008 fiscal year.

Many state hospitals operate fewer beds than they are permitted to by law, the result of a trend in the past two decades toward shorter hospital stays and more outpatient procedures. Over time, hospitals reduced their inpatient beds and replaced them with offices or space for surgeries that do not require an overnight stay.

If an influx of patients were to hit the system, that change could be reversed, temporarily. Many hospital plans for handling a surge of patients call for canceling elective surgeries to free up bed space in recovery rooms and surgical areas, as well as staff who could take care of the patients.

If the demand for inpatient space increased, hospitals might send patients home sooner. Those patients could include people who are healthy enough to go home but don't have home care to ensure that they take their medications, or others who could safely be discharged.

"We might make the decision not to keep them for an extra day for an extra follow-up test," said Kate Roche, the chief operating officer and chief nursing officer at St. Francis Hospital and Medical Center in Hartford.

Although those patients might get more care at home, other patients who are ill but don't need an acute-care setting might find themselves in newly created alternate care hospitals, set up at local colleges or schools, for example. The state has thousands of cots, Guercia said, as well as a 100-bed mobile field hospital that could be set up.

This flu season, Yale-New Haven Hospital has an extra tool: Its new Smilow Cancer Hospital is set to open this fall and won't be full immediately, giving the hospital extra space if necessary, said Dr. Louise Dembry, the hospital epidemiologist at Yale- New Haven Hospital.

In the main hospitals, meanwhile, patients with flu might be assigned to the same floor and the same staff, said Nancy Dupont, infection prevention specialist at the UConn Health Center.

If a large portion of the population gets sick, of course, health care workers probably will, too, and hospitals must plan for having fewer staff on hand when they might be needed most.

At St. Francis, nursing students from the University of Hartford and St. Joseph College could help out in support roles, Roche said. Employees in some departments human resources, for example could be used to deliver food, if necessary.

Any increase in inpatient volume would probably be preceded by a surge in emergency room visits, something that hospitals are monitoring closely, with plans that include potentially triaging patients in separate areas.

Although some states are experiencing an increase in swine flu this fall, Connecticut has not seen a spike in cases. At Hartford Hospital, for example, there have been few cases of swine flu since mid-August. But Dr. Jack Ross, Hartford Hospital's director of infectious diseases and hospital epidemiologist, said that it is only a matter of time. "Connecticut won't be spared from this," he said.

So far, most cases elsewhere in the country do not require hospitalization.

"What we're seeing down south is 300 to 400 children presenting," Ross said. "Most of those cases can be handled with symptomatic therapy. Most of those cases can then go home."

For now, Dembry said, much of the focus has been on teaching people the signs of flu and how to prevent it and on letting people know when they should go to a hospital and when they might be better off staying at home and getting better.