Redesigning emergency department operations amidst a viral pandemic

Abstract

As shown by the current COVID-19 pandemic, emergency departments (ED) are the front line for hospital-and-community-based care during viral respiratory disease outbreaks. As such, EDs must be able to reorganize and reformat operations to meet the changing needs and staggering patient volume. This paper addresses ways to adapt departmental operations to better manage in times of elevated disease burden, specifically identifying areas of intervention to help limit crowding and spread. Using experience from past outbreaks and the current COVID-19 pandemic, we advise strategies to increase surge capacity and limit patient inflow. Triage should identify and geographically cohort symptomatic patients within a designated unit to limit exposure early in an outbreak. Screening and PPE guidelines for both patient and staff should be followed closely, as determined by hospital administration and the CDC. Equipment needs are also greatly affected in an outbreak; we emphasis portable radiographic equipment to limit transport, and an upstocking of certain medications, respiratory supplies, and PPE.

Keywords: COVID-19; Emergency department; Operation; SARS-CoV-2; Staff.

Fig. 1

Clinical decision pathway.

Fig. 2

Cohort symptomatic patient to rooms in an isolated area of the department (blue). Using a static geographic model, designate providers and nurses to be assigned to these areas only. The non-cohort rooms (orange) can remain with the baseline department staffing model.