Pandemic had significant impact on Canada's hospitals

Nov 24, 2010 (CIDRAP News) – More than 15,000 Canadians were hospitalized with pandemic influenza last year, thousands more than in a typical year, which prompted hospitals to cope by employing such steps as reducing the number of planned admissions, according to a report from a government-funded research institute.

About 65% of the hospitalizations occurred in a 5-week period that started at the end of October 2009, during the pandemic's second wave, says the 28-page report from the Canadian Institute for Health Information (CIHI). The report also showed big increases in emergency room visits during the pandemic peak.

"As the first global pandemic in more than 40 years, the response to H1N1 from public health authorities was unprecedented," said Jeremy Veillard, CIHI's vice president of research and analysis, in a press release.

"While there have been suggestions this response may have been exaggerated, our study shows that, in fact, the impact of the virus on hospitals was significant and much higher than originally estimated. The good news is that Canada's acute care facilities were able to weather the storm."

The CIHI said it counted hospitalizations for both confirmed and probable H1N1, because many hospitalizations for unspecified flu are assumed to have been H1N1. The tally of 15,200 hospital cases is about 6,500 higher than the number of lab-confirmed hospitalizations reported at the end of 2009, the group said.

During the 5-week peak period, H1N1 accounted for 3.4% of all hospitalizations in Canada, which exceeded the percentages for such common conditions as heart attacks (2.5%) and strokes (1.6%) during the same weeks, according to the report.

The report covers the period from April, when the pandemic began, through December. The 15,200 flu hospitalizations during that time compares with about 1,300 flu cases recorded for those months in a typical year, the report says. "During the five busiest weeks of the pandemic, almost 10,000 more flu patients were hospitalized than in a typical year," the group said.

During the peak period, hospitals accommodated about half of the pandemic influx simply by increasing their patient populations, as overall hospitalizations were about 1.7% higher than average, the analysts found.

They said hospitals apparently coped with the rest of the increase by "managing occupancy in other areas." The number of patients with pre-booked admissions was 2.7% below normal in the peak period, suggesting that some planned surgical procedures may have been postponed. Also, the number of patients hospitalized for angina was down about 20% during that period, prompting the authors to speculate that more patients than usual were given guidance about managing their symptoms at home.

The CIHI also found that, to make room for flu patients needing intensive care unit (ICU) placement, hospitals in some cases moved patients who typically would've received ICU care to regular rooms with increased monitoring.

Concerning emergency department visits, the authors focused on Ontario, since data were not yet available from other provinces. They found there were about 230,000 visits for flu-like symptoms in October and November 2009, 92% above average for those months. By age-group, the biggest increase was for 5- to 19-year-olds, who accounted for 43,000 visits, more than 200% of normal. But only 2.3% of those patients were admitted.

The CIHI estimated the cost of the pandemic for hospitals at abut $200 million, with about $128 million of that spent during the peak 5-week period.

The report says Canada's response to the pandemic was based on lessons learned during the SARS (severe acute respiratory syndrome) epidemic of 2003, in which Canada was the hardest-hit country outside Asia.

"Our study shows that Canada's hospitals were able to build on what was learned during SARS in 2003 and effectively cope with the high number of H1N1 patients," said Kathleen Morris, head of emerging issues at CIHI, in the press release.

The CIHI describes itself as an independent, not-for-profit research corporation that is funded by the Canadian federal, provincial, and territorial governments.

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