Emergency Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Ghazali, Choquet, Bouzid, and Casalino); Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris, France (Drs Ghazali, Choquet, Bouzid, Peyrony, Fontaine, Sonja, Revue, and Casalino); IAME (Infection, Antimicrobial, Modeling, Evaluation), INSERM, Université de Paris, Paris, France (Drs Ghazali, Bouzid, and Casalino); Emergency Department, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Peyrony, Fontaine, and Casalino); Emergency Department, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France (Drs Sonja and Casalino); Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (Drs Plaisance, Revue, Chauvin, and Casalino); and Emergency Department, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France (Dr Javaud).
Qual Manag Health Care. 2023;32(1):46-52. doi: 10.1097/QMH.0000000000000351. Epub 2022 Apr 4.
The coronavirus disease-2019 (COVID-19) pandemic has imposed unforeseen and unprecedented constraints on emergency departments (EDs). In this study, we detail the organizational and managerial tools recently implemented among 5 academic EDs in a French region particularly affected by COVID-19 and analyze how EDs responded to the COVID-19-related disease burden during different phases of the epidemic. Initially, they focused on the early detection of suspected cases by identifying 3 predominant COVID-19 syndromes. During this diagnostic process, patients were placed in respiratory isolation (facial mask before triage) and droplet isolation (ED rooms). A 3-level strategy for triage, clinical pathways in the EDs, and the organization of hospital spaces was based on the real-time polymerase chain reaction (RT-PCR) COVID-19 positivity rate, with ED strategies adapted to the exigencies of each level. This crisis demonstrated hospitals' adaptability and capacity to mobilize in the face of new risks, with hospitals and EDs coordinating their management to reallocate resources, optimize interoperability, and rethink patient pathways. This report on their processes may assist hospitals and EDs in areas currently spared by the new variants.
新型冠状病毒病-2019（COVID-19）大流行给急诊科（ED）带来了前所未有的限制。在这项研究中，我们详细介绍了最近在法国一个受 COVID-19 影响特别严重的地区的 5 所学术急诊科实施的组织和管理工具，并分析了急诊科在大流行的不同阶段如何应对与 COVID-19 相关的疾病负担。最初，它们通过识别 3 种主要的 COVID-19 综合征来专注于疑似病例的早期检测。在这个诊断过程中，患者被置于呼吸道隔离（分诊前戴口罩）和飞沫隔离（ED 病房）。根据实时聚合酶链反应（RT-PCR）COVID-19 阳性率，采用 3 级分诊策略、ED 临床路径和医院空间组织，ED 策略适应每个级别的紧急情况。这场危机表明医院具有适应新风险的能力和动员能力，医院和 ED 协调管理以重新分配资源、优化互操作性和重新思考患者路径。本报告介绍了他们的流程，可能有助于目前未受新变异影响的地区的医院和 ED。
