Rapid development of a dedicated emergency department follow-up clinic during a large pediatric Shiga toxin-producing E. coli outbreak.

Abstract

Objectives: To describe the rapid development, implementation, and outcomes of a dedicated pediatric Shiga toxin-producing Escherichia coli follow-up clinic during a large outbreak, and to identify operational lessons relevant to future surge events.

Methods: During the 2023 Calgary daycare-associated STEC outbreak, the Alberta Children's Hospital activated an emergency command structure and rapidly established a follow-up clinic for the anticipated surge of children requiring daily assessment and laboratory monitoring. New clinic space was developed by repurposing conference rooms into clinical spaces with workflows designed to support patient flow, safety, and infection prevention. Staffing was achieved through multidisciplinary redeployment and voluntary additional shifts and supported by rapid training and standardized clinical care. Processes were refined using Plan-Do-Study-Act cycles informed by frontline feedback, conversations with families, and direct observation. Operational data were collected and staff feedback was obtained through a post-outbreak survey.

Results: After 2 days of treating patients in a modified pre-existing clinic space, the dedicated clinic opened in repurposed conference room space. Between September 6 and 21, 133 patients accounted for 328 visits that would have otherwise occurred in the ED. The median daily visit volume was 22 (range 1-44), and the median number of visits per patient was 2 (range 1-7). Laboratory testing occurred in 97.6% of visits, 3.5% involved intravenous fluid administration, and 2.1% of visits led to admission. No significant adverse events occurred among discharged patients. Survey respondents shared insights for future preparedness, and 85% rated clinic effectiveness at 8/10 or higher.

Conclusion: Rapid expansion of ambulatory capacity during outbreaks can be achieved through coordinated redesign of space, staffing, systems, and support services. In this model, early command structure activation, repurposing of non-clinical space, standardized protocols, and broad stakeholder engagement enabled safe care while preserving ED capacity. These transferable principles offer a practical approach for managing future outbreaks.