Extending the emergency department during a pandemic

SMH-SV-Extending the ED

St. Michael's Hospital (ED)

Background: The Covid-19 pandemic threatened the ability of emergency departments (EDs) to maintain the provision of quality care. In March 2020, our department faced the imminent threat of a surge in patients affected by Covid-19 and an increased need for space for patient distancing. We aimed to be ready within 2 weeks of March 25 2020 to divert a majority of low acuity patients from the main ED site. Aim statement: Our main outcome measure was the number of patients diverted from the main ED space. Process measures included: date of space readiness and number of staff oriented and available. Balancing measures: adverse events away from appropriate clinical settings. Measures and design: A close collaboration was established between the departments of family and emergency medicine with joint leadership and staffing commitment. A large outpatient clinic space left unused by the sudden transition toward virtual care was repurposed as the ED Low Acuity (ED LAc). Triage, registration and patient transport was planned through iterative process maps. The new space was adapted to its new use, including ED equipment, stocking and physical distancing accommodation. Thirty-eight family physicians were oriented to ED LAc, with 12 rostered for phase 1. Nursing and clerical staffing was ensured by redeployed staff with and without ED experience. A mixed clinical staffing model, new space and workflow were tested through two In-situ simulations, revealing gaps in code blue procedures and patient ED repatriation. The space was ready within 2 weeks. Canadian Journal of Emergency Medicine (2021) 23 (Suppl 1):S1�S93 S77 1 3 Vol.:(0123456789) Evaluation/results: Since the ED patient volumes had decreased by over 50%, the ED LAc opening was postponed by 2 weeks to April 16 2020 and limited to 8 h a day with a planned staged ramp up. Emergency and family physicians were paired for clinical orientation. Low numbers of patients (4�26) received care in ED LAc, reflecting the historically low ED attendance seen during this phase of the COVID-19 pandemic in Ontario. Staffing was reduced to a single physician on May 4, 2020 and ED LAc was suspended on May 29 with protocol plans archived for future re-deployment as needed. No adverse event was recorded. The ED LAc successfully increased ED capacity in a very short time frame, but ultimately turned out to not be needed. Key enabling factors were strong institutional support and leadership, collaboration across departments, iterative process mapping and testing through simulation, and the development of a staged deployment that could match resource utilization to demand.

Samuel Vaillancourt - sam.vaillanncourt@utoronto.ca

Project complete