Ep 138 COVID-19 Part 2 – ED Surge Capacity Strategies in the COVID-19 Pandemic

No matter where you practice emergency medicine there will be, or has been, capacity problems in the COVID-19 crisis. Even if we "flatten the COVID-19 curve" there will be a load on the systems that exceeds our capacity. Dr. Daniel Kollek, emergency physician, chair of the CAEP Disaster Medicine committee and Director of the Centre for Excellence in Emergency Preparedness, answers questions such as: what are the 4 pillars of increasing surge capacity? What are the common pitfalls of alternate care spaces? How can we best manage the degradation of care we provide for our non-COVID patients? How should we use the ED space and beyond to increase surge capacity while keeping our staff safe? and many more... Podcast production, sound design & editing by Anton Helman Written Summary and blog post by Anton Helman, Rowan Helman and Daniel Kollek, March 2020 Cite this podcast as: Helman, A. Kollek, D. ED Surge Capacity Strategies in COVID-19 Pandemic. Emergency Medicine Cases. Month, 2018. https://emergencymedicinecases.com/surge-capacity-strategies-covid-19. Accessed [date] This podcast was recorded on March 19th, 2020 and the information within is accurate up to this date only, as the COVID pandemic evolves and new data emerges. The blog post will be updated regularly and we are working on a weekly update via the EM Cases Newsletter which will be replicated on the EM Cases website. This podcast and blog post are based on Level C evidence - consensus and expert opinion. Examples of protocols, checklists and algorithms are for educational purposes only and require modification for your particular needs as well as approval by your hospital before use in clinical practice. COVID surge capacity Definition of surge capacity Surge capacity is the ratio of patients to medical beds, staff and consumable resources. In a healthcare context, a disaster is defined as the need that is being put on the system outstripping the ability to deliver. Surge capacity is the ability to house and treat patients above the standard volume. 4 methods to increase capacity Decreasing demand Establishing alternate care facilities Minimizing resource consumption by admitted patients Expanding bed capacity 1. Decrease demand in the COVID pandemic to increase capacity Divert patients to alternate facilities Diverting patients away from the ED can be done in many ways. For example, public messaging to advise patients not to present unless completely necessary. Patients who do present unnecessarily to EDs need to be diverted to alternate facilities. These facilities need to be established in the community. Discharge ALC patients to any facilities that can house patients and have beds available Decreasing demand can be done by decreasing the number of patients who are currently in the system. Patients awaiting discharge for other types of care need to be transferred to another facility that can house the patients. Families often want their loved ones to be in a nursing home near them which is sometimes not an option during this time. Defer all nonessential care This can include elective operating rooms and clinics for things that are deferrable. The last segment is delivery of care in a non-traditional way such as video consultations. Using technology to reach the patient; keeping them away from the facility. Patients should not come to the ED for COVID screening, particularly if the patient is asymptomatic. It is important to only come to the ED when the patient thinks they need immediate help regarding their sickness. Coming to the ED can expose patients to other illnesses and puts them at risk. Contact public health, go to a walk-in clinic or see a family doctor,