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Emerg Med J. Dynamic adaptation to COVID-19 in a Singapore paediatric emergency department

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  • Emerg Med J. Dynamic adaptation to COVID-19 in a Singapore paediatric emergency department


    Emerg Med J. 2020 Apr 22. pii: emermed-2020-209634. doi: 10.1136/emermed-2020-209634. [Epub ahead of print]
    Dynamic adaptation to COVID-19 in a Singapore paediatric emergency department.


    Tan RMR1,2, Ong GY3,2, Chong SL3,2, Ganapathy S3,2, Tyebally A3,2, Lee KP3,2.

    Author information




    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.
    ? Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.



    KEYWORDS:

    infectious diseases; paediatrics, paediatric emergency medicine


    PMID:32321705DOI:10.1136/emermed-2020-209634

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