COVID-19 Outbreak Response for an Emergency Department Using In Situ Simulation

Abstract

In January 2020, the WHO declared COVID-19 an epidemic in China and the possibility of evolving into a pandemic. During early phases, most emergency departments did not have contingency plans for an outbreak of this scale and therefore necessitating adequate preparation. This study aims to describe the utility of in situ simulation in identifying system errors and latent safety hazards in response to preparation for the expected COVID-19 surge. We also aim to describe the corrective measures taken to improve our outbreak response locally. We hope that others may be able to use this information as foresight in preparing their own departments for this outbreak. The emergency department and anesthesiology department of Galway University Hospital conducted a series of multidisciplinary, in situ simulations to rapidly identify operational errors and latent safety hazards in response to this outbreak. Each simulation involved an interdisciplinary response to a suspected/COVID-19 patient. The cases were used as a training opportunity for staff and ultimately a platform to expeditiously implement system changes in response to deficits identified during the simulations. Conclusively, with the complexities and intricate structure of every emergency department, we understood that preparation for an outbreak requires evaluation of the current system before implementing any changes. It is not a "one size fits all" concept. Therefore, conducting in situ simulations and the use of foresight, is pivotal as it could prevent loss of resources and time in preparing for an outbreak.

Keywords: anaesthesiology; covid 19; emergency department; emergency medicine; in situ simulation; irish emergency department; latent safety hazards; medical simulation; outbreak response; system testing.

Figure 1. Scenario time from ED resuscitation room to ICU.

Figure 2. Training using in situ simulation. Facilitator (in black) seen taking notes during the simulation.

Figure 3. New airway trolley with only essential equipment.

Figure 4. Specified PPE for resuscitation room use only.

PPE: Personal protective equipment

Figure 5. Security personnel commissioned to clear hallways of staff and patients.

Figure 6. “Red” resuscitation room for potential/COVID-19 positive cases.

Figure 7. “Green” resuscitation room (converted from an ANP room originally used to treat patients with non-acute injuries).

ANP: Advanced nurse practitioner

Figure 8. Additional extension built to function as “Red” and “Green” waiting rooms.

Figure 9. Example of the “Red” waiting room.

Figure 10. Waiting room area converted into “Red” and “Green” triage rooms.

Figure 11. Floor plans of ED (Before changes).

Figure 12. Floor plans of ED (After changes).

Figure 13. Daily meeting of senior-decision makers to update local COVID-19 guidelines and protocol.

Figure 14. Emergency Department COVID-19 Intubation Protocol (Page 1).

Figure 15. Emergency Department COVID-19 Intubation Protocol (Page 2).