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Story from the Field

Name of Health Department/Agency: Kane County Health Department
State: IL
Date Added: 05/14/2009
Themes: Communications - General H1N1,Community Mitigation,Medical Care and Countermeasures,State and Local Coordination,Surveillance and Epidemiology
Issue Summary: Communication is Key: One LHD's Response to the Outbreak of Novel H1N1
Description of Issue(s): The novel H1N1 influenza outbreak has provided numerous challenges to the Kane County Health Department.? With each new issue, KCHD strives to respond accordingly or adapt and overcome. One success story we would like to share describes our strong working relationship throughout the event with other healthcare partners within county.

Kane County is a suburban county 40 miles west of Chicago with approximately 500,000 residents. There are five hospitals, one large private clinic serving over 70,000 visits per year, four federally qualified health centers and one state run mental health facility.
Actions taken to address the issue(s): On Friday, April 24, the KCHD staff began monitoring the novel influenza virus situation as cases appeared in California and Texas. Over the weekend, KCHD staff participated in several media and public health briefings and on Sunday, began formulating the health department?s response.? By Sunday evening, the KCHD Health Protection leadership group, comprised of staff from the Environmental Health, Communicable Disease and Public Health Emergency Response sections, and the Executive Director developed an incident action plan ready to be put into play first thing Monday morning.? One of the first objectives was to set-up a daily briefing meeting with the hospital infection control practitioners and emergency preparedness representatives at each of the five hospitals.? KCHD routinely meets with and works the Infection Control Practitioners and emergency preparedness staff during normal operations.? These relationships made it easy to bring everyone together quickly.

On the first daily briefing call Monday morning with the five hospitals, we quickly realized we needed to include our Federally Qualified Health Centers (FQHCs) and the large private clinic in to the briefing. In order to provide the best information and capture the most relevant information from our partners, we set a standard agenda for each meeting. Each day, we provided a Situation Report and updates from Communicable Disease, Public Information and Public Health Emergency Response. We then asked each organization to provide us with an update from their clinics, Emergency Departments (EDs) and Infection Control. These updates gave us a ground level view of what our partners were experiencing and allowed us to tailor our response to develop and communicate resources that provided the most benefit. We used a continuous Plan, Do, Check, Act model to update the information and resources we were providing. A good example of this was that at one point, a hospital informed us that they were seeing an increase in patients coming in from homeless shelters.? After receiving that information, we worked with the homeless shelters to develop resources and recommendations to help them deal with their clients and to try and reduce any inappropriate surge on the EDs.? The homeless shelters appreciated the resources and the EDs reported a significant reduction in inappropriate ED visits from homeless shelter clients.? This is just one example of how KCHD continually revised our response efforts to best address the rapidly evolving situation.

Coincidentally, just three days prior to our first awareness of the novel influenza outbreak, KCHD?s Public Information Officer hosted the first meeting of the Kane County Public Relations Council bringing together PIOs from school districts, fire departments, police departments, hospitals, clinics and various other organizations.? Although many of the personal relationships existed prior, this meeting was the first step in formalizing an information sharing network to support emergency risk communication.? Our PIO was able to tap into this network on our daily calls with our healthcare partners and to daily revise the public information messages we were putting out to support their responses. For example, our healthcare partners were telling us they were seeing a huge increase in the number of worried well to their EDs and clinics. Our public information messages the next day focused on what signs and symptoms should bring people to their doctor or the ER. On another day, our partners asked us to address the school communities and relay what information should keep kids out of school. The following day, we shared key points and pre-scripted messages addressing this issue with the PIOs in organizations around the county for their use.? As the level of public interest and concern continued to grow, we set-up a Kane County Call Center to take calls from residents who had questions regarding the novel influenza situation.? The Call Center was primarily staffed with volunteers from our Medical Reserve Corps and Office of Emergency Management. Having skilled volunteers who had already been trained in public health emergency response enabled us to effectively handle the influx of calls from residents.? We were then able to share the Call Center phone number with the hospitals and clinics to use in their public information material to help reduce the call volume they were experiencing at each of their organizations.

When supplies from the Strategic National Stockpile arrived in Illinois, the state pushed out packages to us and the five hospitals.? Because the FQHCs and the private clinic are not part of the state SNS push and based on the information we were receiving from them on increased patient surge and a shortage of PPE, we developed PPE packages to deliver to each of the clinics to support their operations and thereby decrease any unnecessary surge on the hospital EDs. The clinics were very appreciative of the PPE they received and the hospitals appreciated the fact that the clinics were better able to manage visits related to the novel influenza strain.

Outcomes that resulted from actions taken: Some of the opportunities for improvement we identified include: The need to engage as many of our healthcare partners as possible right from the outset. It was not until the second week we realized the state run mental health clinic needed to be brought into our daily briefings so they could best manage their unique population of patients and clients. Second, although the daily briefings were voluntary, we had two FQHCs who found it difficult to participate. This created a significant gap in understanding how these organizations were responding and how we could best address any opportunities to support their response before the situation got out of control. Third, we continue to struggle with effectively communicating risk information with our private physician community. Through our county-wide fax number database, information was pushed out to our medical community.? Our Executive Director also had several meetings with the Kane County Medical Society. There still was a perception of a lack of understanding of the situation from private physicians. This continues to lead to conflicting information coming from the schools and health department, and the private physician offices to parents. We continue to look for more effective channels to communicate with these healthcare leaders in our community so that a consistent public health message is disseminated. Finally, when HHS/CDC changed it?s public message from ?public health emergency? to ?no worse than seasonal flu?, seemingly overnight, we struggled to quickly adapt our messages to our partners in the community and to convey the ongoing need for public health preparedness and continued aggressive public health interactions such as exclusion of sick children from school and increased ILI reporting.

The novel influenza outbreak is also providing excellent opportunities to identify strengths in our public health emergency response plans.? When we first recommended, based on the current CDC guidance that particular schools should close due to students with laboratory confirmed illness, we alerted the EDs and clinics in the area to prepare their surge plans, expecting that once the school closed, parents would inevitably rush to have their child tested at the first sign of ILI.? On our daily briefing calls, we provided experts from communicable disease, public information and public health emergency response to address any outstanding issues raised by our healthcare partners. If there was an issue we did not have a direct response to, that became our focus for the next 24 hours and were able to return the next day and provide an actionable suggestion or resource to the requesting organization.? The calls also provided KCHD with a good perspective of what each frontline clinic or ED was experiencing each day. Because KCHD does not provide the same type of direct patient care services, we were better able to tailor our response because we understood what challenges our partners were facing.? In a brief ?in-process review? with our partners on a call last week, each clinic or hospital reported an enhanced situational awareness of the healthcare response across the county. They reported that this helped them to prepare their internal response and staffing surge plans.? The calls also provided a good opportunity to convey a consistent message to all partners simultaneously. If one organization had a question about public information messaging, it was likely that other organizations were facing the same issue and benefited from hearing straight from the horses mouth what our messages were.

As we continue to examine our initial response and move into aggressive preparedness planning throughout the summer, we have identified several opportunities to improve our response capabilities.? We were able to host the daily conference calls with the support of the county?s information technologies division but were frequently challenged by our inability to rapidly set-up calls with short notice and more than 15 participants.? We will be investigating new resources available to provide such a service to the health department and will be trying to leverage any new public health preparedness funding to address this gap, especially around technology. We were also able to tap into the Regional Office of Education?s webcasting resources to communicate with all of the superintendents and principals in the county. Having this same technology available to the health department may have improved our ability to communicate with the healthcare partners in the county. This technology would also vastly improve our ability to effectively communicate even while we are recommending enhanced social distancing measures. Finally, we are exploring improved information management tools to help us manage and organize the vast number of documents, resources and tools we received, developed and shared with many different organizations throughout the response.? We are looking for a web-accessible tool that we can take in all of the information and organize so as to best support our internal and external response activities.? Each of these resources requires funding support and we look forward to sharing more of our successes and challenges with NACCHO in the hopes of effectively communicating the need for continued support of local public health preparedness efforts.

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