Reorganising the emergency department to manage the COVID-19 outbreak

Abstract

Background: The COVID-19 disease outbreak that first surfaced in Wuhan, China, in December 2019, has taken the world by storm and ravaged almost every country in the world. Emergency departments (ED) in hospitals are on the frontlines, serving an essential function in identifying these patients, isolating them early whilst providing urgent medical care. This outbreak has reinforced the role of Emergency Medicine in public health. This paper documents the challenges faced and measures taken by a tertiary hospital's ED in Singapore, in response to the outbreak. Main body: The ED detected the first case of COVID-19 in Singapore on 22 January 2020 in a Chinese tourist and also the first case of locally transmitted COVID-19 on 3 February 2020. The patient journeys through the patient reception area in the ED and undergoes fever screening before being shunted to isolation areas within the ED. Management and disposition of suspect COVID-19 patients are guided by a close-knit collaboration between ED and department of infectious diseases. With increasing number of patients, backup plans for expansion of space and staff augmentation have been enacted. Staff safety is also of utmost importance, with provision and guidelines for personal protective equipment and team segregation to ensure no cross-contamination across staff. These have been made possible with an early setup of an operational command and control structure within the ED, managing manpower, logistics, operations, communication and information management and liaison with other clinical departments. Conclusion: With the large numbers of undifferentiated patients managed by the ED to date, more than 820 patients with COVID-19 have been identified in the hospital. Not a single member of the staff of the SGH Emergency Department has come down with the illness. The various measures undertaken by the department have helped to ensure good staff morale and strict adherence to safety procedures. We share the lessons learnt so that others who manage EDs around the world can benefit from our experience.

A conceptual framework for Emergency department design in a pandemic

“…These zones are routinely staffed with healthcare workers donning appropriate personal protective equipment (PPE) and have negative pressure rooms to limit exposure to other patients and healthcare staff. Hence for COVID-19, when the index case presented to a tertiary hospital in Singapore, the patient was appropriately isolated [ 36 ].…”

Containment of COVID-19 and reduction in healthcare-associated respiratory viral infections through a multi-tiered infection control strategy

“…Emergency department: improved segregation during COVID-19 pandemic Our ED's protocols for the safe management of COVID-19 suspects have been previously published elsewhere. [13][14][15] We evaluated the success of these protocols in the right-siting of COVID-19 patients. In brief, patients with epidemiologic risk factors and patients presenting with clinical syndromes potentially compatible for COVID-19, were strictly segregated in dedicated 'fever areas' (Supplementary Figure 2b).…”

RSNA International Trends: A Global Perspective on the COVID-19 Pandemic and Radiology in Late 2020

“…Facility planning must consider multi-functional facilities with the flexibility to pivot quickly to address different levels of disease outbreaks. In one example, an institution designed a parking garage as an overflow facility that can be converted during civil emergencies (64). In this facility, medical consultation and treatment rooms and a lead lined room for portable x-ray were purpose-built and can be deployed on short notice.…”