key: cord-0761368-8oexf92f
authors: Mohindra, Rohit; Atlin, Cori; Moran, Carla; Shook, Ann; Ennis, Andrea; Page, Jennifer; Vaglica, Marisa; Hannam, Paul
title: Coronavirus disease – 2019 assessment zone: A community hospital's rapid response to a novel infectious pandemic
date: 2020-05-08
journal: CJEM
DOI: 10.1017/cem.2020.391
sha: 03695e15bb932dcd1edcb45ac558a890997e08ad
doc_id: 761368
cord_uid: 8oexf92f

nan

North York General Hospital (NYGH) is a large-sized academic community hospital, situated in Toronto, Ontario, serving a catchment area of 420,000 people. Our annual ED consensus was 113,976 in 2018-2019. In 2003, NYGH was directly affected by severe acute respiratory syndrome (SARS) and built an assessment zone using our ambulance bay. 2 A similar approach has been undertaken now. Our clinical coordinator adapted the existing blueprints (Figure 1 ), mapped out the physical space, and sought in situ feedback from frontline staff. It was constructed over 33 hours and fully functional 30 minutes after opening.

The enhanced protection zone is situated in the ambulance bay. It has a separate entrance and waiting room and is equipped with heating, ventilation, electricity, and an external portable washroom. The walls are made of poly sheathing, which can be cleaned with bleach. The zone has three mobile computers and capacity for bloodwork, electrocardiogram, and portable X-ray. There are eight assessment rooms; nursing and physician tables; and space for support staff, including clerical and facility. Each room has its own stretcher, stethoscope, and donning and doffing area.

The average daily ED census in March 2018 and 2019 were 309 and 315, respectively. The day the enhanced protection zone opened, the ED census was 477. During the first 9 days that the enhanced protection zone was open, the ED received an average of 441 patients per day, with 44% being assessed in the enhanced protection zone. To meet the needs of our diverse patients, we developed translated discharge instructions in different languages, including simplified Chinese and Farsi. Additionally, we created a website for patients to access their COVID-19 swab results.

The enhanced protection zone represents our solution to assessing significantly higher volumes of patients while adhering to infection prevention standards. It was constructed in less than 1.5 days. Once alternative COVID-19 assessment clinics have opened, the enhanced protection zone will have the capacity to house stretcher-bound patients who are not critically ill, leaving the ED for sicker patients. This design represents a viable model for others who need a rapidly deployable physical area, separate from the main ED. 

Premier's Council on Improving Healthcare and Ending Hallway Medicine. Hallway healthcare: a system under strain

SARS assessment clinic: a rapid response to an infectious outbreak