ABSTRACT
Aims: SARS-CoV2 has caused a pandemic in 2020. We describe the creation of an ambulatory sector dedicated to COVID-19 in an emergency department (ED). Procedure: Patients on stretcher or with emergency signs were managed in an ED dedicated area by emergency physicians. The other COVID-19-suspect patients were managed in another area, under a tent, by physicians with another specialty. Paper files were used to save time. Following the national recommendations at that time [Haut Conseil de la santé Publique], nasopharyngeal swabs for SARS-CoV-2 RT-PCR were performed for patients being at risk of severe disease, patients being inhospitalized, healthworkers, and first cases of a new cluster. Results: From March 16th to May 7th 2020, 57 physicians representing 17 medical or surgical specialties different from emergency medicine realized 224 shifts of 5 h. During that period of time, 2039 consultations in the ED were related to COVID-19, of which 1542 took place in the ambulatory care area under the tent. Eventually, 1819 (93 %) consultations led to discharge from hospital, 114 (6 %) to hospitalization in a medical ward, and 23 (1 %) in intensive care unit. Conclusion: Creating dedicated area because of contagiousness, and the large number of patients attending the ED in a short period of time, require caregiver reinforcement. Integration of the reinforcements is easier when a precise procedure has been established and when they are provided with initial teaching and mentoring. Respect of the ED organization allows to provide effective care to all patients. © 2021 Elsevier Masson SAS
ABSTRACT
Résumé But de l’étude: Le SARS-CoV2 a causé une pandémie en 2020. Nous décrivons la création d’une filière ambulatoire COVID-19 au sein du service d’accueil des urgences (SAU). Matériel et Méthodes: Les patients couchés ou avec signes de gravité étaient pris en charge dans une filière dédiée dans le SAU. Les autres patients suspects de COVID-19 étaient pris en charge dans une filière sous tente, tenue par des médecins et chirurgiens non urgentistes. Des dossiers papier étaient utilisés. Les indications de prélèvement ont suivi les recommandations nationales[1], ciblées à l’époque sur les patients avec des facteurs de risque de formes graves, les patients à hospitaliser, le personnel soignant et les premiers cas d’investigation de clusters. Résultats: Du 16 mars au 7 mai 2020, 57 praticiens non urgentistes de 17 spécialités différentes ont assuré 224 vacations de 5h. Sur cette période, 2039 consultations au SAU étaient en lien avec la COVID-19, dont 1542 ont eu lieu dans la filière ambulatoire sous tente. Au final 1819 (93%) consultations ont abouti à un retour au domicile, 114 (6%) à une hospitalisation en secteur conventionnel, et 23 (1%) à une hospitalisation en réanimation. Conclusion: La création de filières dédiées du fait du risque de transmission croisée, et l’afflux de nombreux patients en un court laps de temps, nécessitent des renforts de personnel soignant. L’intégration de ces renforts est d’autant plus facile qu’une procédure précise est établie et qu’ils bénéficient d’une formation et d’un accompagnement initiaux. Le respect de l’organisation en filière permet de répondre efficacement à l’ensemble des demandes de soins. Aims: SARS-CoV2 has caused a pandemic in 2020. We describe the creation of an ambulatory sector dedicated to COVID-19 in an emergency department (ED). Procedure: Patients on stretcher or with emergency signs were managed in an ED dedicated area by emergency physicians. The other COVID-19-suspect patients were managed in another area, under a tent, by physicians with another specialty. Paper files were used to save time. Following the national recommendations at that time[1], nasopharyngeal swabs for SARS-CoV-2 RT-PCR were performed for patients being at risk of severe disease, patients being inhospitalized, healthworkers, and first cases of a new cluster. Results: From March 16th to May 7th 2020, 57 physicians representing 17 medical or surgical specialties different from emergency medicine realized 224 shifts of 5h. During that period of time, 2039 consultations in the ED were related to COVID-19, of which 1542 took place in the ambulatory care area under the tent. Eventually, 1819 (93%) consultations led to discharge from hospital, 114 (6%) to hospitalization in a medical ward, and 23 (1%) in intensive care unit. Conclusion: Creating dedicated area because of contagiousness, and the large number of patients attending the ED in a short period of time, require caregiver reinforcement. Integration of the reinforcements is easier when a precise procedure has been established and when they are provided with initial teaching and mentoring. Respect of the ED organization allows to provide effective care to all patients.