Evolving swabbing practices for COVID-19 in a New Zealand emergency department during the early stages of an emerging pandemic.

OBJECTIVE: To review if tests for suspected COVID-19 were performed according to the Ministry of Health (MoH) case definitions, identify patterns associated with testing outside of the case definition, and discuss the potential impacts on hospital services. METHODS: This was a retrospective audit of patients presenting to the Wellington Hospital ED between 24 March 2020 and 27 April 2020 who were swabbed for COVID-19 in ED. Swabs were audited against the March 15th and April 8th MoH COVID-19 case definitions. RESULTS: Five hundred and thirty-six COVID-19 swabs for 518 patients were taken during the study period. There was poor alignment of testing with the March 15th case definition, with only 11.6% of the 164 swabs taken during this period meeting the case definition. Of the 145 swabs that did not meet the case definition, the majority (n = 119, 82.1%) met symptom criteria only. Alignment of testing with the wider April 8th case definition was much higher with 88.2% meeting criteria. Factors associated with being swabbed despite not meeting the case definitions included fever >38°, a diagnosis of cancer, subsequent hospital admission, and for the March case definition only 'contact with a traveller'. CONCLUSION: There were associations found between testing outside of criteria and specific variables potentially perceived as high-risk. Poor alignment of testing with case definitions can impact hospital services through the (mis)use of limited laboratory testing capacity and implications for resource management. Improved communication and feedback between clinicians and policymakers may improve case definition implementation in a clinical setting.

Emergency Department pandemic preparedness: Putting research into action

Emergency nurses are experts at responding rapidly to change. Their everyday practice involves constant assessment and prioritisation of a dynamic workload to meet the needs of patients across the spectrum of illness and injury. When COVID-19 arrived in Aotearoa New Zealand in February 2020, staff in hospitals around the country rushed to prepare for the wave of infected patients seen overseas. Emergency nurses' ability to adapt to unanticipated situations whilst working in an overcrowded and resource-constrained system made them important contributers to COVID-19 pandemic planning. Finding myself in the unique position of having just completed novel research into the perspectives of emergency nurses around pandemic preparedness, I felt a responsibility to ensure these perspectives were included in the pandemic response at the busy tertiary emergency department where I worked. Key findings from my prior research included the importance of managing the fear nurses felt about getting sick when caring for patients and of spreading disease to their family, friends, or to other vulnerable patients within their care.

Pre COVID-19 emergency department nurses' perspectives of the preparedness to safely manage influenza pandemics: A descriptive exploratory qualitative study.

BACKGROUND: Pandemics pose significant challenges to healthcare systems worldwide and emergency departments are a crucial component in any pandemic response. This study was designed to explore what New Zealand emergency nurses perceive as the major challenges to nursing care and staff safety during a pandemic, and to identify strategies nurses feel are important in mitigating these challenges. METHODS: A descriptive exploratory qualitative design using semi-structured interviews was conducted in March 2019. Participants were 16 triage nurses from two New Zealand emergency departments. Qualitative content and thematic data analysis techniques were used. RESULTS: Emergency nurses highlighted existing safety issues in their practice, and their concerns about how a pandemic might exacerbate these issues. These themes were identified as: safety of self and family, safety of patients, and safety of organisational systems. Nurses also shared their perspectives on how to mitigate these safety issues. CONCLUSIONS: This study provides a detailed understanding of the concerns emergency nurses hold about working during pandemics. Similar fears for staff and patient safety have been voiced globally during the current COVID-19 pandemic, and it is crucial that emergency departments worldwide develop pandemic plans that address the safety concerns to which fear was attributed.