Emergency medicine journal : EMJ
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Using emergency physicians' abilities to predict patient admission to decrease admission delay time.
In many EDs, emergency physicians (EPs) do not have admitting privileges and must wait for consultants to further assess and admit patients. This delays bed requests and increases ED crowding. We measured EPs' abilities to predict patient admission prior to consultation and estimated the potential ED stretcher time saved if EPs requested a bed with consultation. ⋯ Crowding is a reality for EDs worldwide, and many systems could benefit from EP-initiated hospital admissions to decrease the amount of time admitted patients wait in the ED.
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The COVID-19 outbreak has posed unique challenges to the emergency department rostering. Additional infection control, the possibility of quarantine of staff and minimising contact among staff have significant impact on the work of doctors in the emergency department. Infection of a single healthcare worker may require quarantine of close contacts at work. ⋯ All these were measures to limit interactions among healthcare workers. With the implementation of the roster, measures were also taken to bolster the psychological wellness of healthcare workers. With face-to-face contact limited, we also had to maintain clear, open channels for communication through technology and continue educating residents through innovative means.
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Given the high risk of healthcare worker (HCW) infection with COVID-19 during aerosol-generating medical procedures, the use of a box barrier during intubation for protection of HCWs has been examined. Previous simulation work has demonstrated its efficacy in protecting HCWs from cough-expelled droplets. Our objective was to assess its ability to protect HCWs against aerosols generated during aerosol-generating medical procedures. ⋯ This is in contrast to the box barrier alone, where vapour diffused towards the feet of the patient and throughout the room, and to no barrier where the vapour immediately diffused to the laryngoscopist. This demonstrates that the box with the plastic sheet has the potential to limit the spread of aerosols towards the laryngoscopist, and thus may play a role in protecting HCWs during aerosol-generating medical procedures. This is of particular importance in the care of patients with suspected COVID-19.
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As the COVID-19 pandemic has created shortages of vital personal protective equipment that threatens healthcare workers' risk of exposure, a need for innovative new ways to protect healthcare workers has emerged. An aerosol containment box that covers the patient's head and neck in bed provides a solution to protect clinicians during aerosol-generating procedures such as intubation. ⋯ The container is outfitted with an ultra-low particulate air-equipped filtration vacuum device to create negative pressure within the chamber and actively remove floating droplet nuclei generated during a procedure. This barrier method will be a valuable and economical option to protect healthcare workers on the front line globally during this pandemic and beyond.