Dynamic adaptation to COVID-19 in a Singapore paediatric emergency department. Issue 5 (22nd April 2020)

• Record Type: Journal Article
• Authors: Tan, Ronald Ming Ren; Ong, Gene Yong-Kwang; Chong, Shu-Ling; Ganapathy, Sashikumar; Tyebally, Arif; Lee, Khai Pin
• Is Part Of: Emergency medicine journal. Volume 37:Issue 5(2020)
• Page Start: 252
• Page End: 254
• Publication Date: 2020-04-22
• Subjects: paediatrics, paediatric emergency medicine -- infectious diseases; Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emermed-2020-209634
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : Singapore was one of the earliest countries affected by the coronavirus disease 2019 (COVID-19) pandemic, with more laboratory-confirmed COVID-19 cases in early February 2020 than any other country outside China. This short report is a narrative review of our tertiary paediatric emergency department (ED) perspective and experience managing the evolving outbreak situation. Logistic considerations included the segregation of the ED into physically separate high-risk, intermediate-risk and low-risk areas, with risk-adapted use of personal protective equipment (PPE) for healthcare personnel in each ED area. Workflow considerations included the progressive introduction of outpatient COVID-19 testing in the ED for enhanced surveillance; adapting the admissions process particularly for high-risk and intermediate-risk cases; and the management of unwell accompanying adult caregivers. Manpower considerations included the reorganisation of medical manpower into modular teams to mitigate the risk of hospital transmission of COVID-19. Future plans for a tiered isolation facility should include structural modifications for the permanent isolation facility such as anterooms for PPE donning/doffing; replication of key ED functions in the tent facility such as a separate resuscitation room and portable X-ray room; and refresher PPE training. Dynamic reassessment of ED workflow processes, in conjunction with the hospital and national public health response, may help in managing this novel disease entity.