TABLE 2.
Scoping Search Results
| Title | Source (Journal, Website…) | Team Member/Actor | Concern | Mechanism (How To) |
|---|---|---|---|---|
| Covid-19 Podcast From Italy With Roberto Cosentini30 | St. Emlyn’s Blog https://www.stemlynsblog.org/covid-19-podcast-from-italy-with-roberto-cosentini-st-emlyns/ |
Emergency department physicians | Surge | Split ED into “Lung Diseases Unit” and “Other Diseases Unit” |
| Timing for structural modifications | Prepare in time - during the onset phase because presentation rate grow exponentially | |||
| Treatment of COVID-19 patients depending on oxygen and ventilation | Divide the “Lung Diseases Unit” (contaminated path) into a high, medium, and low intensity areas | |||
| Hospital medical direction | Hospital admission increase | Create spaces | ||
| COVID-19 Update: An Interview With Andrea Duca, MD33 | EMplify Emergency Medicine Podcast https://blubrry.com/emplify/57487286/episode-38-covid-19-update-an-interview-with-andrea-duca-md/ |
Emergency department physicians | Spread of the disease | Create a contaminated/dirty Area and dedicated pathway |
| Timing to create dirty area | Progressively adapt to the increasing surge of patients | |||
| Not enough space | Create open space wards and waiting areas where patients are treated while waiting for hospital boarding | |||
| Cohort patients with COVID-19 to gain space | ||||
| PPE shortage | Change gloves between patients | |||
| Shortage of equipment and supplies | Rationalize use of equipment and materials | |||
| COVID-19: A Powerful Message From Italy34 | REBEL EM Blog https://rebelem.com/covid-19-a-powerful-message-from-italy/ |
Emergency department physicians | Spread of the disease | Creation of 2 divided paths inside the ED: a contaminated and a clean one |
| Change in respiratory diseases prevalence | Adapt and repurpose spaces to the increasing prevalence, remodeling on the base of oxygen sources and ventilators – dedicating most of the department to see acute respiratory patients. Leave a small clean area of the ED for non-suspect patients |
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| Timing of changes | Progressively change but expect an exponential increase of presentations so enact changes quickly. | |||
| Hospital medical direction | PPE shortage | Reduce shifts and dedicate personnel to the dirty path to reduce PPE wastage | ||
| Oxygen shortage | Pay attention to oxygen administration | |||
| COVID-19 Emergency Department Response Strategies35 | American College of Emergency Physicians https://www.acep.org/globalassets/new-pdfs/covid-19-for-emergency-department-response-strategies.pdf |
Emergency medicine physicians | Risk of contamination/exposure; PPE shortage |
Reduce episodes of donning and doffing/patient encounter |
| Increasing intercommunication and “door” exam | ||||
| Create a screening point outside of the hospital | ||||
| Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-236 | National Academy of Medicine https://nam.edu/duty-to-plan-health-care-crisis-standards-of-care-and-novel-coronavirus-sars-cov-2/ |
Emergency medicine physicians | Increasing presentation rates | Repurpose current rooms/areas to isolation rooms and infectious care areas |
| Cohorting patients | ||||
| Boarding, discharge, and admission waiting areas. | ||||
| National Strategic Plan for Emergency Department Management of Outbreaks Of COVID-1937 |
American College of Emergency Physicians https://www.acep.org/globalassets/sites/acep/media/by-medical-focus/covid-19-national-strategic-plan_0320.pdf |
Emergency medicine physicians and hospital medical direction | Spread of disease | Separate areas for patients with respiratory symptoms |
| Maximize distance between patients (at least 6 feet) | ||||
| Protocols for people accompanying patients in waiting areas and visitors | ||||
| Emergency medicine physicians, hospital medical direction, cleaning service | Spread of disease | Protocols for decontamination | ||
| Hospital medical direction | Increased presentation and admission rates | Opening unused areas, patient cohorting, doubling up inpatient rooms |
||
| EUSEM Position Paper on Emergency Medical Systems Response to COVID-1938 | European Society of Emergency Medicine https://eusem.org/news/505-eusem-position-paper-on-emergency-medical-systems-response-to-covid-19 |
Emergency department | Spread of the disease | Increase number of isolation rooms, possibly with negative pressure and adequate ventilation |
| Favor physical barriers between patients | ||||
| Specific triage areas for suspect patients | ||||
| Create patient dedicated waiting areas for suspects before boarding | ||||
| Minimization of movements for suspect patients (ED, radiology, bathrooms) | ||||
| Cohorting of patients is reasonable | ||||
| Maintain a distance of at least 1 meter | ||||
| Don’t allow visitors or co-operators in the area | ||||
| Cleaning service | Spread of the disease | Specific decontamination protocols | ||
| Treat waste from the contaminated area as a high risk biological material | ||||
| Emergency department | Increased presentation rate | Limit access to ED to patients with severe symptoms. Asymptomatic or mild symptomatic patients should seek advice to GP | ||
| PPE shortage | Increase stockpiles and supplies | |||
| COVID-19 First Line – 10 Topics From the EDs During Corona39
(Prima Linea COVID-19 - 10 cose… dai PS ai tempi del Corona) COVID-19 First Line Report – Organizational Structure of EDs Before and During the Outbreak40 (Rapporto prima linea COVID-19 - Assetto organizzativo gestionale dei PS/DEA nell’ambito di focolaio epidemico o pre-epidemico) |
Italian Society of Emergency Medicine (Società Italiana Medicina d’Emergenza-Urgenza) https://www.simeu.it/w/articoli/leggiArticolo/3992/leggi https://www.simeu.it/w/articoli/leggiArticolo/3964/leggi |
Emergency department | Increased presentation rate | Prepare to the surge at least 10 days before |
| Repurpose areas increasing possibility of ventilatory support | ||||
| Spread of the disease | Reduce visits and activities to essentials | |||
| Create “filter zones” (forward triage or screening areas) | ||||
| Separate Areas for Suspect infectious patients | ||||
| PPE shortage | Increase stockpiles and supplies | |||
| Oxygen shortage | Increase stockpiles and supplies | |||
| Checklist for Healthcare Facilities: Strategies for Optimizing the Supply of N95 Respirators during the COVID-19 Response41 | Centers for Disease Control and Prevention https://www.cdc.gov/coronavirus/2019-ncov/hcp/checklist-n95-strategy.html |
Emergency Department | Spread of the disease, PPE shortage | Use isolation rooms |
| Use physical barriers between patients | ||||
| Maintain adequate ventilation |