Patients Urged Not to Delay or Be Fearful of Emergency Care

LEXINGTON, Ky. (April 27, 2020) - As the coronavirus pandemic continues to evolve, hospitals around the world are adapting their systems to treat patients as efficiently as possible.

UK HealthCare doctors want to reassure patients that the emergency department is open and ready for any urgent or emergency situation, COVID or non-COVID, when they happen.

Before COVID-19, the UK Chandler Hospital Emergency Department was nationally recognized for its newly structured ED patient intake system, which reduced door to doctor times and significantly cut down on the number of patients leaving without being seen.

Since the pandemic began, the volume of patients seeking care in the UK Chandler Hospital ED is down more than 50%. Dr. Daniel Moore, the assistant medical director for Emergency Medicine, said those numbers are on par with national statistics.  

"The most recent data shows that ED's nationally are at 50% of their pre-COVID volume and pediatric emergency departments are down 77%. That is consistent with what we're seeing at UK," he said. "We're also seeing emergency heart attack visits are down 40%, suggesting that there is a fear associated with coming to the ED."

To help mitigate both patient and staff exposure to possible COVID-19 patients, UK HealthCare has once again taken on the challenge of restructuring the department to meet the needs of patients by essentially creating two emergency departments — a non-COVID-ED and a COVID-ED. Through this system, any suspected COVID patients are kept completely separate from all other patients as they enter the waiting room. There are a number of ways this has achieved this separation, including adding a rapid testing and telemedicine site in the emergency department.

"We want patients to know that it is safe to come to our emergency department if you feel that you are having a medical emergency," Moore said. "You will be protected from coronavirus."

Right now, the average time it takes to see a provider in the emergency department is 10 minutes and the waiting room is consistently empty. So far, no patients have left without being seen. Dr. Joel Hamm, a UKHC emergency medicine physician, helped to spearhead the new COVID patient intake system.

"If patients who need to be evaluated for medical emergencies are staying away from the hospital, this will become another public health emergency," Hamm said. "We have the experience and expertise to rapidly deploy additional resources if volume rises again to maintain patient safety."

How it works

There are a number of steps being taken to keep patients and staff safe. For example, when a patient arrives at the front door, he/she is immediately greeted by staff in what's called a "forward triage" model.

"We are triaging patients as they walk through the door. They are asked a series of questions to determine whether they have coronavirus symptoms," Hamm said. "From there, the patients are separated — potential COVID cases versus non-COVID cases."

If a patient is deemed non-COVID, he/she is brought to the non-COVID main ED and treated.

Patients who are identified as possible positive cases are immediately masked up and brought back to the respiratory pod, where they will be assigned to a private room.

Treatment looks different in this area — all staff are dressed head-to-toe in proper PPE with masks, eye protection, gowns and gloves, and they are required to change out their equipment with each patient encounter. Plus, thanks to a virtual telemedicine system, health care staff are able to limit their contact with patients during treatment.

Depending on his/her condition, this virtual treatment is not possible for every patient; however, when it is in use, you will only see one or two health care workers physically in the room with the patient. Otherwise, the patient will talk with the physician through an iPad.

Moore helped to get this system up and running.

"Staff are much less likely to contract or spread COVID by using this model," Moore said. "Thankfully, we have had very few positive staff cases at this point."

After a COVID-positive patient is discharged from the hospital, their room is cleaned extensively by housekeeping staff who wear full PPE.

The UKHC Makenna David Pediatric Emergency Department also is making changes to handle patient intake, said Dr. Gena Cooper is the assistant medical director of Pediatric Emergency Medicine. Her staff is working under a similar system, which keeps pediatric-specific nursing staff from crossing over to infectious care while caring for non-infectious patients.

"We are maintaining infection-free zones for care of common pediatric problems," Cooper said. "Children who arrive to the emergency department for concerns that are not infectious will be roomed separately from children who have concerning infectious symptoms."

Children who have the most concerning infectious symptoms are placed in a special room in the emergency department that has negative flow. This allows oxygen to be removed from the room so that it does not circulate through the ED.

So far, UKHC has seen a very low prevalence of COVID cases in the pediatric population, with only one positive case in patients under the age of 10 who have been tested.