Gayathri Devi Nadarajan1, Eunizar Omar2, Benjamin S Abella3, Pei Shan Hoe4, Sang Do Shin5, Matthew Huei-Ming Ma6,7, Marcus Eng Hock Ong8,9. 1. Department of Emergency Medicine, Singapore General Hospital, 1 Outram Road, Singapore City, 169608, Singapore. gayathri.devi.nadarajan@singhealth.com.sg. 2. Department of Emergency Medicine, Sengkang General Hospital, Sengkang, Singapore. 3. Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, USA. 4. Duke-NUS Graduate Medical School, Singapore City, Singapore. 5. Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea. 6. Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan. 7. Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou City, Taiwan. 8. Department of Emergency Medicine, Singapore General Hospital, 1 Outram Road, Singapore City, 169608, Singapore. 9. Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore City, Singapore.
Abstract
BACKGROUND: The current COVID-19 pandemic is highlighting gaps around the world in the design and workflow of Emergency Departments (ED). These gaps have an impact on both patient care and staff safety and represent a risk to public health. There is a need for a conceptual framework to guide ED design and workflow to address these challenges. Such a framework is important as the ED environment will always remain vulnerable to infectious diseases outbreaks in the future. AIMS: This paper aims to address issues and principles around ED design and workflow amidst the COVID-19 pandemic. We propose a conceptual framework and checklist for EDs to be prepared for future outbreaks as well. METHODS: A scoping literature review was conducted, of the experiences of EDs in managing outbreaks such as SARS, H1N1 and COVID-19. The combined experiences of the authors and the experiences from the literature were grouped under common themes to develop the conceptual framework. RESULTS: Four key principles were derived- (1) situational awareness, surveillance and perimeter defence, (2) ED staff protection, (3) surge capacity management and (4) ED recovery. The findings were integrated in a proposed conceptual framework to guide ED design in response to an infectious disease outbreak. There are various elements which need to be considered at ED input, throughput and output. These elements can be categorised into (1) system (workflow, protocols and communication), (2) staff (human resources), (3) space (infrastructure), and (4) supply (logistics) and are placed in a checklist for pragmatic use. CONCLUSION: The ED needs to be in a constant state of preparedness. A framework can be useful to guide ED design and workflow to achieve this. As all ED systems are different with varying capabilities, our framework may help EDs across the world prepare for infectious disease outbreaks.
BACKGROUND: The current COVID-19 pandemic is highlighting gaps around the world in the design and workflow of Emergency Departments (ED). These gaps have an impact on both patient care and staff safety and represent a risk to public health. There is a need for a conceptual framework to guide ED design and workflow to address these challenges. Such a framework is important as the ED environment will always remain vulnerable to infectious diseases outbreaks in the future. AIMS: This paper aims to address issues and principles around ED design and workflow amidst the COVID-19 pandemic. We propose a conceptual framework and checklist for EDs to be prepared for future outbreaks as well. METHODS: A scoping literature review was conducted, of the experiences of EDs in managing outbreaks such as SARS, H1N1 and COVID-19. The combined experiences of the authors and the experiences from the literature were grouped under common themes to develop the conceptual framework. RESULTS: Four key principles were derived- (1) situational awareness, surveillance and perimeter defence, (2) ED staff protection, (3) surge capacity management and (4) ED recovery. The findings were integrated in a proposed conceptual framework to guide ED design in response to an infectious disease outbreak. There are various elements which need to be considered at ED input, throughput and output. These elements can be categorised into (1) system (workflow, protocols and communication), (2) staff (human resources), (3) space (infrastructure), and (4) supply (logistics) and are placed in a checklist for pragmatic use. CONCLUSION: The ED needs to be in a constant state of preparedness. A framework can be useful to guide ED design and workflow to achieve this. As all ED systems are different with varying capabilities, our framework may help EDs across the world prepare for infectious disease outbreaks.
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