Redesigning emergency department for a safer surge capacity during COVID-19 pandemic

ABSTRACT

Background and objectives: The COVID-19 pandemic has proved itself to be the greatest global health disaster and overwhelm any healthcare system. Hence, it is paramount that we consider our approach in the management and distribution of resources in light of this pandemic. The aim of this project was to draw up a modified surge capacity plan, to facilitate patient's admission, and ensure safety of patients and healthcare workers. In view of that, a Surge Capacity Preparedness and Response Plan For COVID Pandemic Emergency Department Hospital Selayang was implemented due to an increase in patients' volumes and access block. All patients shall be triaged according to severity based on Malaysian Triage Category and the probability of COVID infection based on recent Case Definition of Clinical Criteria and Epidemiological by Ministry of Health, Malaysia. Methods: A Quality Improvement Project was conducted in the Emergency and Trauma Department, Hospital Selayang (ETDHS). Using a driver diagram, we were able to focus on the multiple key areas that includes reducing non-emergency visits, expanding and utilizing all available space, proper clean and dirty zoning system, and improving the work flow employed in facilitating patients' review, treatment, and admission. Results: The emergency department (ED) overall admission volume increased by 50% compared to before the pandemic. New zoning system showed there was increase in critical zone patients and reduction in total number of patients in non-critical zones (MDSU/fever center/COVID tent/green zone) from 78% to 76% with proper triaging and workflow system. Before the implementation of the new zoning system, there were eight confirmed COVID-19 cases with majority (87.5%, n=7) who were initially triaged to "clean" zones and caused cross-contamination. However, after the implementation of the new system, it was found that all the patients who were tested positive for COVID-19 (100%, n=6) were successfully isolated during the initial triage stage to the respective respiratory/"dirty" zones. Conclusion: The implementation of new zoning system in the ED during COVID-19-associated patient surge successfully improved patient flow, reduced over-crowding and non-emergency visits, decreased cross-contamination, increased the awareness and knowledge, and subsequently prevented transmission of COVID-19 among healthcare staffs.