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, back-up 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.

Keywords: COVID-19; Emergency department.

Fig. 1

Graphic representation of dormitory workers contributing to national tally [9]

Fig. 2

Staff in full personal protective equipment when attending to patients

Fig. 3

Fever screening form

Fig. 4

Ambulatory surgery centre as an expansion of ED fever area

Fig. 5

Exterior facade and interior layout of patient care area in the forward screening area

Fig. 6

SGH emergency department leadership and operational organisation for COVID-19 outbreak. Each clinical team leader is in charge of a team of doctors, in a team-based 12-h roster format. For each shift, each team will allocate doctors to see patients in resuscitation room (P1), trolley area (P2), ambulatory area (P3), observation room (Obs) and fever (isolation) area