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A conceptual framework for Emergency department design in a pandemic

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Authors
Nadarajan, Gayathri D; Omar, Eunizar; Abella, Benjamin S; Hoe, Pei S; Do Shin, Sang; Ma, Matthew H; Ong, Marcus E H
Issue Date
2020-12-17
Publisher
BMC
Citation
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2020 Dec 17;28(1):118
Keywords
SARS-CoV-2, COVID-19Emergency departmentOperationPandemicFramework
Abstract
Background
The current COVID-19 pandemic is highlighting gaps around the world in the design and workflow of Emergency Departments (ED). These gaps have an impact on both patient care and staff safety and represent a risk to public health. There is a need for a conceptual framework to guide ED design and workflow to address these challenges. Such a framework is important as the ED environment will always remain vulnerable to infectious diseases outbreaks in the future.

Aims
This paper aims to address issues and principles around ED design and workflow amidst the COVID-19 pandemic. We propose a conceptual framework and checklist for EDs to be prepared for future outbreaks as well.

Methods
A scoping literature review was conducted, of the experiences of EDs in managing outbreaks such as SARS, H1N1 and COVID-19. The combined experiences of the authors and the experiences from the literature were grouped under common themes to develop the conceptual framework.

Results
Four key principles were derived- (1) situational awareness, surveillance and perimeter defence, (2) ED staff protection, (3) surge capacity management and (4) ED recovery. The findings were integrated in a proposed conceptual framework to guide ED design in response to an infectious disease outbreak. There are various elements which need to be considered at ED input, throughput and output. These elements can be categorised into (1) system (workflow, protocols and communication), (2) staff (human resources), (3) space (infrastructure), and (4) supply (logistics) and are placed in a checklist for pragmatic use.

Conclusion
The ED needs to be in a constant state of preparedness. A framework can be useful to guide ED design and workflow to achieve this. As all ED systems are different with varying capabilities, our framework may help EDs across the world prepare for infectious disease outbreaks.
ISSN
1757-7241
Language
English
URI
https://hdl.handle.net/10371/173573
DOI
https://doi.org/10.1186/s13049-020-00809-7
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College of Medicine/School of Medicine (의과대학/대학원)Emergency Medicine (응급의학전공)Journal Papers (저널논문_응급의학전공)
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