Emergency Department Management-A Case of ‘Severe Respiratory Tract Infection’ Dr T Suresh Kumar FRCEM, Dip HEP (UK) Senior Consultant Emergency Medicine Hamad General Hospital, HMC 23/03/2019
Conflict of Interest As a speaker in this session, I have no conflict of interest or disclosure in relation to this presentation.
Learning Objectives At the end of this session, participants will be able to: Describe the Screening and Triage Process of a patient with a severe respiratory tract infection Describe the Isolation and Patient Flow Pathway across the Department How the patient is stabilised Describe protecting the rest of the patients and the staff Describe the communication process with public health department
Suspected Case of Severe Respiratory Tract Infection Case in HGH Screening before Registration Fever / cough / URTI Mode of arrival Self/private EMS * *: HMC Ambulance service Supervisor will inform ED Supervisor/ Overall In-charge and IC link prior to patient arrival, to prepare for MCI
Pre Screening at the Entrance Self assessment questionnaire as above Surgical mask provided with multi linguistic self help instructions
Screening at the Registration Screening at the Registration Visual Triage Screening by the trained ED Nurse at Registration Counter Fever, cough, SOB, Sore throat, Recent travel, Contact with sick people, Contact with Farm animals Provide surgical mask Stable (walking & Yes No talking)
Stable Patients (Walking & Talking) Stable Patients (Walking & Talking) • Patients wear Surgical mask • Register the patient • Move to decontamination room for male • Move to the MCT area for female • Triage by the ED Nurse • Then assessed by ED physician
Stable Patients (Walking & Talking ) ED physician assessment* Investigate: CXR/ Swabs If the patient requires more If not required to stay, investigation** and treatment investigate** further discharge transfer to isolation rooms and home on home isolation manage accordingly. instructions, treatment. Contact If suspected contact IC -link details taken for follow up by the nurse on duty- 44395318 IC Link + SCH *: Staff wearing PPP **: Complete the Communicable Disease Notification
Stable Patients (Walking & Talking) Stable Patients (Walking & Talking) • If suspected Infectious disease- • • If not suspicious of communicable disease – then treat as regular patient • Precaution: Isolation Respiratory Contact & Airborne Isolation • Display isolation Indicator outside the room / curtain
Unwell Patients Move them to isolation rooms 1 to 5 • • Register the patient in isolation room • ED Nurse triage as a priority ED physician assessment – resuscitation, • investigations & treatment Initiate investigations’- • – Bloods (sepsis Screen) – Blood culture – Nasal swabs for viral Respiratory PCRs – AFB – CXR Initiate treatment and monitor response to • treatment – Sepsis Bundle activation – Board spectrum Abx as per HMC policy – Anti viral – Monitoring – Critical Care
Reassessment of the patient • R • Reassess after resuscitation • Review the labs, POC investigation results • If the report is normal (negative)- treat as regular patient, arrange follow up as per HMC policy • If the report is Positive (abnormal) o Minimise further movement within ED whilst pending admission o Admit under the ED Observation Medicine with isolation precaution o Admit under IP isolation room o Admit and Shift to CDC
Isolation & Cohort Capacity (in HGH) Surge Capacity • Decontamination Room: 6 sitting patients • Isolation Room 7: 8 patients • Family waiting: 4 patients • GCC MUA waiting room: 6 patients • MCT: 9 patients (3 in each cubicle) • FST Cubicle 4: 3 patients • Isolation Room: 4 patients (cubicles)
Staff Precautions • All involved staff wear gown, gloves, hand hygiene. • All staff in ED should be trained to practice proper hand hygiene and use of personal protective equipments (PPE) and be fully aware about MERS-CoV pathway (CL7246 ) • Environmental cleaning and decontamination of ED should follow hospital policy (CL7235 ) • Activate staff protection plan in case of accidental exposure. • Monitor staff compliance with this policy and other related policies
tkumar@hamad.qa Thank you.
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