Wearing PPE is a game-changer, but it is not a simple matter. Patients who test positive will go to areas where the staff wear personal protective equipment. How much of the ED geography will be dedicated to COVID-19 will depend upon whether that ED is in a hotspot Are you seeing one infected person an hour or possibly one infected person a day? Areas would be designated as COVID or non-COVID areas, as the chart below demonstrates. In an ideal state, we will have rapid testing available upon arrival. We must design patient segmentation that will cohort patients and keep them safe. Factor into this the carrier capacity of the young, asymptomatic patients who appear well, and the ED intake process must protect vulnerable populations from the virus. Given the significant contagion factor inherent in the COVID-19 pandemic, and the difficulty in identifying those who may be infectious, ED arrivals in the age of the pandemic need even more sophisticated streaming. Once COVID-19 hit our communities, such patient streaming models were upended. Having a physician handle sorting is also a best practice because they have a good idea of what resources will be required and how long the patient will need to be in the department. The most effective departments staffed these areas with medical teams, had internal waiting rooms to optimize the use of treatment spaces in each zone, and a physician in triage in charge of the complicated patient-sorting process. Admission Holding Area (for boarded patients who are stable waiting for a bed).Critical Care (for very ill sick or injured trauma patients).Major Care or Acute Care (for severely ill patients treated in a bed).Mid Track or Vertical Model (for moderately sick patients treated often in lounge chairs).Fast Track (for the least sick moved quickly in and out of treatment spaces).Dozens of scholarly works-including studies published in International Emergency Nursing, Emergency Medicine Journal, Western Journal of Emergency Medicine and Academic Emergency Medicine-have proven this sorting strategy is effective.Īs ED volumes have grown (the typical pre-COVID-19 ED was processing 110 patients a day), the number and sophistication of patient streams increased and often included the following: This is part of the Institute of Medicine’s aim to get the right patients to the right resources in a timely fashion. For approximately 40 years, ED leaders have pulled lower acuity patients into what is most commonly known as the Fast Track. To those who understand ED best practices, sorting patients into acuity-based patient streams (also called patient segmentation) is the most efficient way to deliver care. Now more than ever-safe care delivery is all about patient flow. That said, the COVID-19 pandemic has caused patient volumes to surge in many communities and has presented ED leaders with the additional challenge of trying to mitigate the risks of virus contagion and spread. Further modelling is recommended to formally test these observations.Emergency departments serve as the front door for many hospitals, so the need for effective patient streaming flows has always been imperative. No relationship between POST and ED length of stay was found, perhaps due to competing ED National Emergency Access Targets (NEAT). The findings suggest a relationship between ED occupancy levels and both ambulances waiting at the ED door and average POST at larger hospitals. We examine ambulance arrival data from the QAS and ED patient arrival data from 15 major metropolitan hospitals across Queensland, to understand temporal variations in POST performance and examine the relationship between POST performance and ED crowding. Queensland Ambulance Service (QAS) shares patient load across multiple hospitals, and receiving facilities strive to meet a Patient Off Stretcher Time (POST) target of 30 minutes. While it is widely accepted that whole of hospital solutions are necessary to reduce the ever-increasing burden on the public health system, little research has focussed on understanding the relationship between ambulance arrival related flow metrics and emergency department (ED) crowding.
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