Revised Triage and Surveillance Protocols for Temporary Emergency Department Closures in Tertiary Hospitals as a Response to COVID-19 Crisis in Daegu Metropolitan City
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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DOI：
10.3346/jkms.2020.35.e189
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发表时间：
2020-05-18
影响因子：
4.5
通讯作者：
Kim, Yang Hun
中科院分区：
文献类型：
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作者：
Chung, Han Sol;Lee, Dong Eun;Kim, Yang Hun
背景资料：当急诊病人被诊断出患有新发传染病时，韩国的医院可能会暂时关闭急诊室（Els），以防止院内传播。自二零二零年二月以来，由于2019冠状病毒病（COVID-19）危机，伊莱古的Ell已连续多次关闭。然而，突然关闭Ell违反了提供紧急医疗服务的法律，使公众能够获得及时，适当和24小时的紧急医疗服务。因此，本研究确定了大邱三级医院的艾德的脆弱性与现行标准。方法：本研究回顾性地在2020年2月18日至3月26日因COVID-19关闭艾德的大都市中的6个1级或2级ED进行。评估了艾德封堵术的现状、患者特征以及胸部X线摄影和实验室检查的结果。根据经验，从重复的Ell关闭和修改后的系统，目前正在使用的Ells，修订分流和监测protocols已经制定和proposed.Results：在研究期间，6级1或2急诊室包括在研究中被关闭27次，769小时。31例确诊的COVID-19病例，其中7例死亡，与艾德关闭的发生有关。在不到50%的患者中观察到具有COVID-19呼吸道症状的典型患者表现，而在93.5%的研究人群中检测到胸部影像学检查的异常结果。胸部X线摄影设施、复苏室和分诊区被转移到艾德外的位置，并应用新的监测方案来确定阻止隔离的因素，包括症状、胸部X线摄影结果和暴露于感染源。实施修订后的分诊和监测方案后，Ell关闭的发生率下降。结论：急诊医生的分诊筛查和外部胸部成像设施的监测方案在COVID-19患者的早期隔离中是有效的。在新出现的传染病的未来爆发中，应将努力集中于提供持续的Ell治疗，并实施经修订的分诊和监测方案。
Background: When an emergency-care patient is diagnosed with an emerging infectious disease, hospitals in Korea may temporarily close their emergency departments (Ells) to prevent nosocomial transmission. Since February 2020, multiple, consecutive Ell closures have occurred due to the coronavirus disease 2019 (COVID-19) crisis in llaegu. However, sudden Ell 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 Ell closures and the modified systems that are currently used in Ells, 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 Ell 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 Ell treatment with the implementation of revised triage and surveillance protocols.