Objective:
Emergency departments (ED) face unforeseen surges in low-acuity patients during pandemics, such as COVID-19. Streamlining patient flow using telemedicine in an alternative care area can reduce overcrowding and promote physical distancing between patients and clinicians, thus limiting personal protective equipment (PPE) use. This quality improvement project describes critical elements and processes in the operationalization of a Telemedicine-Enabled Drive-through and Walk-in Garage Care System (Tele-Garage) to improve ED throughput and save PPE during three COVID-19 surges in 2020.
Method:
Standardized workflows were established for the operationalization of the Tele-Garage for patients presenting with respiratory illness. Statistical control charts present interrupted time series data on the ED length of stay (ED-LOS) and PPE use in the week before and after deployment in March, July, and November 2020.
Results:
Physical space, technology infrastructure, equipment, and staff workflows were critical to the operationalization of the Tele-Garage. On average, ED-LOS decreased 17%, from 4.24 hours during the week prior to opening to 3.54 hours during Tele-Garage operation. There was an estimated 25-41% reduction in PPE use during this time.
Conclusion:
Lessons learned from this effective telemedicine-enabled alternative care area implementation can be used for disaster preparedness and management in the ED setting to reduce overcrowding, improve throughput, and conserve PPE during a pandemic.