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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

Journal of Korean Medical Science 2020년 35권 19호 p.189 ~ 189
정한솔 ( Chung Han-Sol ) - Kyungpook National University School of Medicine Department of Emergency Medicine

이동은 ( Lee Dong-Eun ) - Kyungpook National University School of Medicine Department of Emergency Medicine
김종군 ( Kim Jong-Kun ) - Kyungpook National University School of Medicine Department of Emergency Medicine
여인환 ( Yeo In-Hwan ) - Kyungpook National University School of Medicine Department of Emergency Medicine
김창호 ( Kim Chang-Ho ) - Kyungpook National University School of Medicine Department of Emergency Medicine
박정배 ( Park Jung-Bae ) - Kyungpook National University School of Medicine Department of Emergency Medicine
서강석 ( Seo Kang-Suk ) - Kyungpook National University School of Medicine Department of Emergency Medicine
 ( Park Sin-Yul ) - Yeungnam University College of Medicine Department of Emergency Medicine
김정호 ( Kim Jung-Ho ) - Yeungnam University College of Medicine Department of Emergency Medicine
김균무 ( Kim Gyun-Moo ) - Catholic University of Daegu School of Medicine Department of Emergency Medicine
이석희 ( Lee Suk-Hee ) - Catholic University of Daegu School of Medicine Department of Emergency Medicine
 ( Cheon Jeon-Jae ) - Keimyung University Dongsan Hospital Department of Emergency Medicine
김양헌 ( Kim Yang-Hun ) - Daegu Fatima Hospital Department of Emergency Medicine

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.

키워드

COVID-19 Crisis; Temporary ED Closure; Nosocomial Transmission; Revised Triage; Surveillance Protocol; Chest X-ray
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