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Revised Triage and Surveillance Protocols for Temporary Emergency Department Closures in Tertiary Hospitals as a Response to COVID-19 Crisis in Daegu Metropolitan City

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Author(s)
Han Sol ChungDong Eun LeeJong Kun KimIn Hwan YeoChangho KimJungbae ParkKang Suk SeoSin-Yul ParkJung Ho KimGyunmoo KimSuk Hee LeeJeon Jae CheonYang Hun Kim
Keimyung Author(s)
Jeon, Jae Cheon
Department
Dept. of Emergency Medicine (응급의학)
Journal Title
Journal of Korean medical science
Issued Date
2020
Volume
35
Issue
19
Keyword
COVID-19 CrisisTemporary ED ClosureNosocomial TransmissionRevised TriageSurveillance ProtocolChest X-ray
Abstract
Background:
When an emergency-care patient is diagnosed with an emerging infectious disease, hospitals in Korea may temporarily close their emergency departments (EDs) to prevent nosocomial transmission. Since February 2020, multiple, consecutive ED closures have occurred due to the coronavirus disease 2019 (COVID-19) crisis in Daegu. However, sudden ED closures are in contravention of laws for the provision of emergency medical care that enable the public to avail prompt, appropriate, and 24-hour emergency medical care. Therefore, this study ascertained the vulnerability of the ED at tertiary hospitals in Daegu with regard to the current standards. A revised triage and surveillance protocol has been proposed to tackle the current crisis.

Methods:
This study was retrospectively conducted at 6 level 1 or 2 EDs in a metropolitan city where ED closure due to COVID-19 occurred from February 18 to March 26, 2020. The present status of ED closure and patient characteristics and findings from chest radiography and laboratory investigations were assessed. Based on the experience from repeated ED closures and the modified systems that are currently used in EDs, revised triage and surveillance protocols have been developed and proposed.

Results:
During the study period, 6 level 1 or 2 emergency rooms included in the study were shut down 27 times for 769 hours. Thirty-one confirmed COVID-19 cases, of whom 7 died, were associated with the incidence of ED closure. Typical patient presentation with respiratory symptoms of COVID-19 was seen in less than 50% of patients, whereas abnormal findings on chest imaging investigations were detected in 93.5% of the study population. The chest radiography facility, resuscitation rooms, and triage area were moved to locations outside the ED, and a new surveillance protocol was applied to determine the factors warranting quarantine, including symptoms, chest radiographic findings, and exposure to a source of infection. The incidence of ED closures decreased after the implementation of the revised triage and surveillance protocols.

Conclusion:
Triage screening by emergency physicians and surveillance protocols with an externally located chest imaging facility were effective in the early isolation of COVID-19 patients. In future outbreaks of emerging infectious diseases, efforts should be focused toward the provision of continued ED treatment with the implementation of revised triage and surveillance protocols.
Keimyung Author(s)(Kor)
전재천
Publisher
School of Medicine (의과대학)
Citation
Han Sol Chung et al. (2020). Revised Triage and Surveillance Protocols for Temporary Emergency Department Closures in Tertiary Hospitals as a Response to COVID-19 Crisis in Daegu Metropolitan City. Journal of Korean medical science, 35(19), e189. doi: 10.3346/jkms.2020.35.e189
Type
Article
ISSN
1598-6357
Source
https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e189
DOI
10.3346/jkms.2020.35.e189
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/43179
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학)
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