• Rômulo Rebouças Lobo, Marcos Carvalho Borges, Fábio Fernandes Neves, Bento Vidal de Moura Negrini, Francisco Antonio Colleto, José Luiz Romeo Boullosa, Maria Camila de Miranda Cardoso, and Antonio Pazin-Filho.
• University Hospital of the Medical School of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil.
• Emerg Med J. 2011 Sep 1;28(9):754-7.

BackgroundOccupational risk due to airborne disease challenges healthcare institutions. Environmental measures are effective but their cost-effectiveness is still debatable and most of the capacity planning is based on occupational rates. Better indices to plan and evaluate capacity are needed.GoalTo evaluate the impact of installing an exclusively dedicated respiratory isolation room (EDRIR) in a tertiary emergency department (ED) determined by a time-to-reach-facility method.MethodsA group of patients in need of respiratory isolation were first identified--group I (2004; 29 patients; 44.1±3.4 years) and the occupational rate and time intervals (arrival to diagnosis, diagnosis to respiratory isolation indication and indication to effective isolation) were determined and it was estimated that adding an EDRIR would have a significant impact over the time to isolation. After implementing the EDRIR, a second group of patients was gathered in the same period of the year--group II (2007; 50 patients; 43.4±1.8 years) and demographic and functional parameters were recorded to evaluate time to isolation. Cox proportional hazard models adjusted for age, gender and inhospital respiratory isolation room availability were obtained.ResultsImplementing an EDRIR decreased the time from arrival to indication of respiratory isolation (27.5±9.3 × 3.7±2.0; p=0.0180) and from indication to effective respiratory isolation (13.3±3.0 × 2.94±1.06; p=0.003) but not the respiratory isolation duration and total hospital stay. The impact on crude isolation rates was very significant (8.9 × 75.4/100.000 patients; p<0.001). The HR for effective respiratory isolation was 26.8 (95% CI 7.42 to 96.9) p<0.001 greater for 2007.ConclusionImplementing an EDRIR in a tertiary ED significantly reduced the time to respiratory isolation.

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