Coping with COVID-19: The Royal Surrey Emergency Department Experience

The COVID-19 pandemic has represented a challenge for the Sanitary Systems all over the World, forcing them to adapt quickly to a new reality, where many potentially (or confirmed) infective patients require proper evaluation and management. The primary purpose of the Trusts during the peak of the pandemic was to preserve in-hospital bed capacity, maintaining at the same time high standards of care and safety for the patients.T he Emergency Department, considered to be the hospital's front door, plays a crucial role in managing the patients' flow. If the ED fails in streaming patients efficiently, this inevitably reduces the performance, resulting in overcrowding, increased waiting time, space issues and poor infection risk control. Moreover, possible over admission, related to the concern about rapidly deteriorating respiratory presentations, causes inappropriate hospital bed allocation and Medical review of patients that could have been discharged. In this scenario, the rationale behind the development and introduction of an ED COVID-19 clinical admission tool (ECAT) was to facilitate the decision to admit or discharge, guaranteeing care's suitability. Together with the use of ECAT for the evaluation of patients at high risk for COVID infection, it has been necessary to reorganize the whole ED, with the implementation of a specific front door triage and the division of the Department in "High" and "Low" probability areas, each one of them with its own dedicated Resus, to maintain quality of care and infection control at the same time. This audit aimed to assess the safety of the A&E management of suspected COVID patients in light of the ECAT development and application and assess its impact on patient flow.The audit considered a whole-day (24 hours) snapshot data, six randomly selected days from mid-March 2020 (cycle 1, initial implementation stage) and six randomly selected days from mid-May (cycle 2). A retrospective analysis of patients’ records was done. Between the first and the second cycle, continuous departmental education on ECAT was pursued, together with the opening of alternative pathways to help Doctors with clinical decisions (e.g., the Virtual Clinic for suspected COVID patients follow-up). Exclusion criteria were applied to the paediatric population (>18yo) since the paediatric ED was run by the Paediatric Department, separately from the general A&E