The current year may have been difficult for people from all walks of life, but the COVID-19 scare revealed much of what’s been lacking from various sectors. It gripped the world in fear, and it’s moving fast. Measures have been put in place to contain it, but these have only divided the masses further. At the same time, people are not seeking medical attention when they need to. Many hospitals were said to be overwhelmed with patients, and people were forced to seek treatment elsewhere or suffer the consequences.
The emergency department has seen massive change due to the chaos of this situation. Since March, hospitals are now more secured and have been preparing staff and security to treat any patients who may have a virus safely. The public must be aware that they can still seek treatment even if it’s a non-COVID case, and hospital staff must also be just as ready to help these patients.
When a medical institution has limited resources, they evaluate the sick and the wounded and categorize them according to their conditions. This is also how emergency rooms assess patients who need care when the department is crowded. A triage staff is a medical team in charge of various tasks and responsibilities to assist patients with COVID-19.
A triage nurse identifies those that are likely to succumb to the virus. They can redirect infected patients to a designated room without implying their high-risk condition. The triage staff must also have the patience to deal with patients who are suspected cases, as the fear promoted around the virus through media has rendered everyone very nervous.
During the COVID-19 pandemic, a primary triage goal is to implement procedures to detect patients who are considered persons under investigation (PUI). These are typically people with a travel history to areas where the virus was prevalent.
The staff must practice hygiene protocols at all times, and designate infection prevention by properly cleaning and treating emergency room equipment. They may also provide supplies such as alcohol, sanitizers and contactless trash bins in various public areas of the hospital.
Changes And Improvements
Steps and guidelines have been mandated to lessen the risk of the virus spreading in hospital premises. These guidelines are said to be for the protection of the patients under the institution’s care, the doctors, nurses and the other hospital personnel. COVID-19 has completely altered old policies to adapt to the current state of various communities.
- Precautionary Measures
- Screening And Testing
It all starts at the ER entrance and admission check-in.
Everyone in the hospital will undergo screening to determine their risk factor of contracting the virus. Staff members, physicians and other personnel who go to work daily undergo screening every day. Anyone showing symptoms is immediately isolated from patients and the rest of the team where they will undergo testing as needed.
Patients are also tested before admission, and three days before any major medical procedure. Patients displaying symptoms of the coronavirus must come alone. If they test positive, they must notify family members by calling or messaging them. Those with non-COVID symptoms and accompanied by family members are all given surgical masks to wear.
Safety measures may also be the reason why surgical procedures have been cancelled or rescheduled. Patients can inquire about it by calling their doctor or surgeon.
According to Healthline, there has been a decrease in visitations of heart attack patients between 40% to 60% since the pandemic. The cause of the decline is out of fear of contracting the virus. To help safeguard patients, hospitals prepared separate emergency rooms for receiving patients who have non-COVID symptoms. There are staff and specialists to attend heart patients as well as those with other illnesses, who require urgent care.
- Universal Masking
Every patient, visitor (if allowed), and member of staff is required to wear a mask. Children as well, except for those who are under two years old. Healthcare workers are provided with personal protective equipment, or PPEs, including goggles and N95 masks, especially those who are treating COVID-19 patients.
Patients, in turn, may remove masks when alone in their rooms and put them on again when the medical staff or hospital personnel enters. Wearing a mask is one of the best preventative measures and lessens the risk of transmission.
- Social Distancing
Preventing overcrowding at the ER is vital. Some hospitals implement at least 6ft of distance in waiting rooms by separating the seats. Others will restrict visitation and shorten the schedules to lessen the possibility of viral transmission. Certain entrances are often closed off to avoid traffic. Only the essential workers are retained for the care of the patients. Physicians, specialists and nurses are the only ones exempt from the 6ft-social distancing rule.
- Cleanup And Disinfection
Cleanup crews or housekeeping have strict guidelines on how to perform cleaning tasks to prevent the spread of the virus. Procedural efforts were intensified to disinfect shared surfaces, public areas such as the waiting room, common areas that the staff are using, and public restrooms. Shared tools and equipment undergo a meticulous cleaning process after use by each patient, especially those who have contracted the virus. Terminal cleaning commonly involves the following:
- Hospital-approved disinfectant
- Microfiber mops
- Large bio-waste bags
- Surgical masks
- Waste containers
- Electrostatic spray
Some hospitals may have negative pressure rooms with dedicated ventilation. The airflow is directed to prevent viral spread. Any patient who is displaying symptoms must temporarily stay within this room.
To prevent further spread of the coronavirus, hospitals put a limit on in-person communication within their respective facilities. However, as most health institutions have learned, this presents a problem with how they communicate in emergency cases. Effective communication is essential every time a medical team must assemble, execute briefings, coordinate roles, and address various questions from the institution’s authorities.
- Text Messaging, Phone Calls, and Emails
At this time, two-way text messaging proved very useful, as staff could read and review information in-between tasks. Data is passed on from one health worker to another to communicate operation plans, resource tracking, assessments and more. The hospital website can help to provide information to anyone who has Internet access. It may also have a back office for hospital personnel where they can view announcements and news.
Two-way text messaging prompts the recipient to reply to a message immediately, to show that it was received. At times, phone calls and emails are also useful, if the recipient isn’t able to respond via text at that moment. It also saves on time, as essential healthcare workers don’t have to walk from one department to another.
- Telehealth Services
The pandemic prompted the Office for Civil Rights (a section of the Department of Health and Human Services) to waive penalties for noncompliance on specific privacy and security regulatory requirements. Covered health workers who are subject to the HIPAA Privacy, Security and Breach Notification Rules, or the HIPAA Rules, have been allowed to use audio or video communication technology to provide telehealth services to patients during the COVID-19 national emergency. It ensures safety for both the health care workers and the patients, to help contain the spread of the virus.
Below is a list of HIPAA-compliant video communication apps that health care workers and patients can use:
- Microsoft Teams
- Google Hangouts
- Amazon Chime
- Cisco Webex Meetings
- Webex Teams
- Zoom for Healthcare
- Spruce Health Care messenger
If you feel that you have a life-threatening disease, do not hesitate to seek emergency care. You should call 911 if you’re not sure how best to proceed, especially when it’s your first time. The emergency room is always open to receiving patients who are dealing with the following:
- Animal bites
- Severe bleeding
- High fever
- Loss of consciousness (someone may phone for you)
- Head injuries
- Broken bones
- Chest pain
- Blurry or loss of vision
- Severe burns
Patients with other medical concerns should call their doctor’s office first. Medical staff may suggest the use of an online appointment, or face-to-face communication via messaging apps. Expect that you will need to undergo screening and testing for COVID-19 if necessary. A prepared medical team is likely to receive the patient the moment they arrive.
In non-emergency cases such as colds, flu, sinusitis, allergies, urinary tract infections and the like, call your doctor’s office. Physicians may choose to engage with you via videocall or phone call instead.
- Patient Transport
Some patients need lab tests, x-rays, and many other procedures for which they must be transferred to another part of the hospital. There is a section of medical staff designated for taking care of non-COVID patients to make sure that they are transferred on time.
The staff implements social distancing by making sure that only one patient at a time is brought in. Pharmacists are now also meeting patients at the entrance upon departure, as it is safer than coming to their rooms to review medication information.
The transporters are routinely changing masks and other equipment every two hours, to help to ensure their safety. Frequent handwashing has also become a standard routine, especially when handling different patients. Transport items such as wheelchairs and stretchers are immediately disinfected after use.
- Labor And Delivery Patients
Pregnant women who suspect that they have the coronavirus must inform the obstetrics department of the hospital. Their temperatures will be taken and they will be tested to determine whether or not they are high-risk. It will help the hospital prepare for the delivery with infection control in mind.
An ambulance will be sent for them, and they will be transported to the appropriate entry of the hospital. The driver will then inform the receiving end while following transport guidelines and protocols. The infection control team must be notified before the arrival of the pregnant COVID-19 patient.
Pregnant patients who are displaying coronavirus symptoms are prioritized in testing first. Visitors are limited to one family member, partner or relative. If the patient has been screened and a fever develops, they will not be allowed entry.
Limiting the visitation times and a number of people coming to the hospital help control the virus and protects everyone involved. You may be contacted through phone, or may also be directed to use video call apps such as FaceTime, Google Hangouts, Skype or other similar messaging programs. Adults of at least 18 years old are the only visitors permitted on the premises. You may also ask if the hospital has its own application that will allow patients and family to communicate.
In children’s hospitals, two healthy parents are allowed to visit a patient. However, only one must remain by the bedside at a time. Parents may decide on shifts to help look after the child. Siblings are not permitted to visit for the meantime, to avoid contamination. Parents should limit the number of times that they go in and out of the hospital as a precaution. Visitation schedules and rules may still apply, even during the holidays.
- Equipment And Bio-Waste Disposal
Emergency physicians and nurses practice strict measures such as careful removal and disposal of PPEs and masks after coming close to a COVID-19 patient. Preventing contamination is a priority to keep the rest of the hospital safe.
According to the Department of Environmental Quality in the state of Oregon, medical wastes are not considered infectious. These include masks, gowns, gloves, disposable wipes, swabs and any other pieces of medical equipment that aren’t bloody are considered to be regular trash and don’t need treatment. However, those that need incineration or sterilization are called biological wastes – material saturated with blood and bodily wastes, serums, cultures, stocks, biopsies and vaccines.
Emergency rooms are the primary receiving facility for patients with COVID-19. During the pandemic, they’ve had to adopt measures to accommodate both COVID and non-COVID patients. Separate teams are drilled and given roles to fulfil, to make sure that every patient who goes through the hospital doors receives appropriate care. The staff must follow the new guidelines and protocols to protect themselves as well as the patients. It will help to reassure the patients that they’re in good hands, in just the same way as before the pandemic.