Original Article
Lessons learnt from handling an outbreak of gastroenteritis from the emergency department perspective
Abstract
Background: The purpose of this study was to examine the response of an emergency department (ED) to a gastroenteritis outbreak involving 76 patients and to identify the lessons learnt and challenges involved.
Methods: The response of an ED to a gastroenteritis outbreak was reviewed via a chart review and interviews with personnel involved.
Results: There were 76 associated patient visits. All were healthy male patients with mean 37 (19–49 years) with no co-morbidities. The presentations continued over five days with the peak incidence of cases on the first day. The most common symptoms were diarrhea (100%), abdominal pain (88.2%) and fever (86.8%). The department instituted a protocol on the night of the breakout, assigning a specific area of the department for the management of these patients and designating specific staff to focus on these patients. All repeat visits received cultures and stool studies, as well as antibiotics. Two stool cultures were positive for S. Entiritidis. Forty-two patients were discharged, 20 patients were observed for eight hours and five patients were admitted. One patient was eventually diagnosed with appendicitis and underwent an appendectomy.
Conclusions: Major gastroenteritis outbreaks put a strain on ED resources. A pragmatic approach is necessary to reduce the number of unnecessary admissions. At the same time, in the era of bio terrorism, the physicians involved must keep a lookout for potential red-flags. Whilst cohorting patients aid in maximizing workflow and infection control, physicians need to remain vigilant for potential dual pathologies.
Methods: The response of an ED to a gastroenteritis outbreak was reviewed via a chart review and interviews with personnel involved.
Results: There were 76 associated patient visits. All were healthy male patients with mean 37 (19–49 years) with no co-morbidities. The presentations continued over five days with the peak incidence of cases on the first day. The most common symptoms were diarrhea (100%), abdominal pain (88.2%) and fever (86.8%). The department instituted a protocol on the night of the breakout, assigning a specific area of the department for the management of these patients and designating specific staff to focus on these patients. All repeat visits received cultures and stool studies, as well as antibiotics. Two stool cultures were positive for S. Entiritidis. Forty-two patients were discharged, 20 patients were observed for eight hours and five patients were admitted. One patient was eventually diagnosed with appendicitis and underwent an appendectomy.
Conclusions: Major gastroenteritis outbreaks put a strain on ED resources. A pragmatic approach is necessary to reduce the number of unnecessary admissions. At the same time, in the era of bio terrorism, the physicians involved must keep a lookout for potential red-flags. Whilst cohorting patients aid in maximizing workflow and infection control, physicians need to remain vigilant for potential dual pathologies.
