The Role of the Emergency Department in Protecting the Hospital as a Critical Infrastructure in the Corona Pandemic Strategies and Experiences of a Rural Sole Acute-Care Clinic

Abstract

Background. The Klinikum Hochrhein is responsible as a regional sole provider for the acute and emergency medical treatment of more than 170.000 people. Against the background of the pandemic spread of SARS-CoV-2 with expected high patient inflows and at the same time endangering one's own infrastructure due to intraclinical transmissions, the hospital management defined the maintenance of one's functionality as a priority protection objective in the pandemic. An essential strategic element was a very short-term restructuring of the Emergency Department with the objectives of reducing the number of cases within the clinic, detecting COVID-19 cases as sensitively as possible and separating the patient pathways at an early stage. Methods. The present work is a retrospective analysis of the processes and structures established in the Emergency Department between 27 March 2020 and 20 May 2020. In addition, a retrospective descriptive evaluation of the epidemiological and clinical data of the patients is carried out at the time of first contact during the period mentioned above. Results. After establishing a pre-triage with structured algorithms, all confirmed COVID-19 cases were identified before entering the clinic and assigned to an appropriate treatment pathway. Unprotected entry into hospital structures or nosocomial infections were not observed, although almost 35% of patients with confirmed infection were admitted due to other symptom complexes or injuries. 201 inpatient patients were initially isolated without COVID-19 being confirmed. The number of cases in the Emergency Department was 39% lower than the previous year's period, thus avoiding crowding. Discussion. The reduction in the number of cases was strategically intended and is primarily the result of a restrictive indication of in-clinical treatment but supported by a decline in emergency consultations that can be noticed anyway. The proportion of false positive triage results is probably dependent on epidemiological activity and was accepted for safety reasons as sufficient resources were available for isolation. Conclusion. Short-term organizational, spatial and procedural restructuring of the ZNA has enabled the clinic to achieve its goal of managing the pandemic. The algorithms we developed are particularly well suited to guarantee the desired level of safety in the case of a high pre-test probability.

Molecular point-of-care testing for SARS-CoV-2 using the ID NOW™ System in Emergency Department: Prospective Evaluation and Implementation in the Care Process

“…Patients aged 14-100 (median age 63) recruited into the study were included irrespective of the reason for referral to the emergency department but showed symptoms associated with COVID-19 and / or a high epidemiological risk (Table 1) [3,13]. The evaluation of the collected findings within the scope of the study was carried out with the consent of the patients and completely anonymised.…”

“…Experiences from the so-called "first wave" of the pandemic in the area surrounding the clinic (February to May 2020), highlighted that a correct classification of patients is not possible when solely based on clinical and epidemiological criteria [3]. Real-time PCR has been considered the gold standard in the diagnosis of SARS-CoV-2 infections but results take at least 24 hours (on average 36-48 hours) at the Klinikum Hochrhein since this testing has to be outsourced to an external laboratory.…”

“…This is actually common practice since most hospitals do not have their own in-house facilities. During the initial stage of the pandemic, the application of the clinicalepidemiological algorithms, developed by the Klinikum Hochrhein, led to the isolation of a large number of patients over at least 24 hours as a precaution even though only 20% were actually confirmed as a "positive case" [3]. Against a rising tide of incidences and hospital admissions from Autumn 2020 onwards, there was an urgent need for rapid, reliable testing procedures for detecting cases of SARS-CoV-2 in our Emergency Department (emergency care level 2).…”

Implementation and impact of rapid SARS-CoV-2 point of care test on patient flow in the frailty pathway; A quality improvement approach

“…As the pandemic progressed, it was imperative that providing rapid diagnosis of COVID-19 cases was crucial in maintaining and optimizing patient care in hospitals. In addition, rapid testing was also important to help timely decision-making for patient placement and transfers, and to prevent nosocomial infections within the healthcare setting [5][6][7][8].…”

Rapid Emergency Department Physical Space Modifications for COVID-19: Keeping Patients and Health Care Workers Safe

“…7 Also, health care professionals in a German acute care clinic took precautions and set up a 3-point entry system with a pre-triage screening point to prevent intra-hospital contamination. 8 Center for Disease Control and Prevention (CDC) guidelines and studies on infection prevention from Italy suggest patient care should occur in negative airflow or neutral airflow rooms. 9,10 Many busy EDs utilize hallway spaces and vertical flow models to address high patient volumes and in-patient boarding.…”