Dynamic adaptation to COVID-19 in a Singapore paediatric emergency department

Abstract

Singapore was one of the earliest countries affected by the coronavirus disease 2019 (COVID-19) pandemic, with more laboratory-confirmed COVID-19 cases in early February 2020 than any other country outside China. This short report is a narrative review of our tertiary paediatric emergency department (ED) perspective and experience managing the evolving outbreak situation. Logistic considerations included the segregation of the ED into physically separate high-risk, intermediate-risk and low-risk areas, with risk-adapted use of personal protective equipment (PPE) for healthcare personnel in each ED area. Workflow considerations included the progressive introduction of outpatient COVID-19 testing in the ED for enhanced surveillance; adapting the admissions process particularly for high-risk and intermediate-risk cases; and the management of unwell accompanying adult caregivers. Manpower considerations included the reorganisation of medical manpower into modular teams to mitigate the risk of hospital transmission of COVID-19. Future plans for a tiered isolation facility should include structural modifications for the permanent isolation facility such as anterooms for PPE donning/doffing; replication of key ED functions in the tent facility such as a separate resuscitation room and portable X-ray room; and refresher PPE training. Dynamic reassessment of ED workflow processes, in conjunction with the hospital and national public health response, may help in managing this novel disease entity.

Impact of COVID-19 on pediatric emergencies and hospitalizations in Singapore

“…To date, it has claimed more than 1 million lives and infected more than 50 million worldwide [2]. COVID-19 has impacted the way medicine is practiced and the provision of health services in all specialties [3][4][5][6].…”

Not just little adults: preparing a children’s emergency department for COVID-19

“…A vital learning point for any new ED building will be to ensure that it is pandemic ready, ensuring safe ventilation, availability of negative pressure rooms, a layout that can be quickly adapted to cohorting and dedicated areas for radiology and treatments. 6 For example, our current three-bedded resuscitation area is small and separated only by curtains, creating difficulties for staff and families when performing aerosol generating procedures (AGP) and our reception desk was open to the patient waiting area (originally seen as child friendly).…”

Electronic medical record platform enhancements duringCOVID‐19 to supportidentify‐isolate‐informstrategy for initial detection and management of patients

“…Following the outbreak of COVID‐19, the department introduced a quick screening tool based on the Ministry of Health (MOH) criteria to sieve out suspect cases. A quick pre‐triage screening was initiated at the entrance to our ED and the patients with risk for COVID‐19 were segregated into two risk‐stratified areas to segregate high‐risk and low‐risk patients within our isolation facility 3,4 . This workflow was essential to quickly identify, isolate to help containing the disease and prevent community spread.…”

“…A quick pre-triage screening was initiated at the entrance to our ED and the patients with risk for COVID-19 were segregated into two riskstratified areas to segregate high-risk and low-risk patients within our isolation facility. 3,4 This workflow was essential to quickly identify, isolate An innovation project of another ED in our regional healthcare cluster led to the introduction of an electronic version of preconsultation questionnaire. Following registration, a short message service (SMS) alert is delivered to the patient's hand phone.…”