Five-Minute Consult

Nick Cagliuso
Corporate director of emergency management
Continuum Health Partners
New York City

Cagliuso developed a comprehensive "swine flu" plan that will help his system's EDs, which see more than 250,000 people a year, open to H1N1 cases and shunt the "worried well" to lower-acuity sites. He's prepared for a potential outbreak by stockpiling supplies and pharmaceuticals and has set a plan in motion to compel healthcare worker vaccinations as well as contingency plans for making sure hospitals have the staffing levels they need.

Nick Cagliuso: We've put into place patient rapid discharge policies. We need to get people out as quickly as we can to make room for others we expect to present. I'm a stickler for folks who say doing this is an ED problem. It's not an ED issue—it's a hospital throughput issue. The ED takes the hit because it's the only department that doesn't have an "out." To help, we have everything from agreements with local police to close off streets to establish tents, to other alternate triage models.

We've identified task forces consisting of an RN, a physician, and an admission clerk who see people with flulike symptoms in another area and in one stop determine whether they can handle them there or if they need to go to the ED. In all cases, anyone presenting with symptoms will get a surgical mask, isolation, and sanitizing gel. Maybe the biggest issue is that clinicians are also getting sick, as are people in their families. So we have policies about sending sick clinicians home, which is served by internal Web-based resources and getting non-ED staff to help us out with the surge. Each hospital has identified folks from administrators to clinicians who could support ED operations through alternate scheduling, extending shifts, and recalling vacations.

—Philip Betbeze