Impact of a binary triage system and structural reorganization of emergency department on health care workers exposed to suspected COVID-19 patients—a single-centre analysis

Abstract

Background A binary triage system based on infectivity and facilitated by departmental restructuring was developed to manage suspected COVID-19 patients with an aim to provide effective prevention and control of infection among health care workers (HCWs) in the emergency department. This study analyses the effectiveness of the new triage system and structural reorganization in response to the COVID-19 pandemic. Methods A cross-sectional observational study was conducted in the Emergency and Trauma Department, Hospital Kuala Lumpur (ETDHKL). The implementation of a binary triage system separates patients with risk of COVID-19 who present with fever and respiratory symptoms from other patients. Data on exposed HCWs to COVID-19 patients were captured pre-restructuring and post-restructuring of the emergency department and analysed using descriptive statistics. Results A total of 846 HCWs were involved in this study. Pre-restructuring reported 542 HCWs exposed to COVID-19 patients while post-restructuring reported 122. Using the four categorical exposure risks for HCWs which are no identifiable risk, low risk, medium risk, and high risk, the number of HCWs exposed during pre-restructuring were 15(1.8%), 504 (59.6%), 15 (1.8%), and 8 (0.9%), respectively, while post-restructuring the numbers were 122 (14.4%), 8 (0.9%), 109 (12.9%), and 5 (0.1%), respectively. There was a 77.5% reduction in the number of exposed HCWs after our implementation of the new system (542 vs 122). Conclusion A binary triage system based on severity and infectivity and supported with structural reorganization can be effective in reducing HCWs COVID-19 exposure.

Kuala Lumpur train collision during the COVID-19 pandemic

“…Since the start of the pandemic, the Emergency Department in HKL operated with a binary system whereby the treatment zones were divided into 'clean' and 'dirty' areas. The details of this system have been recently published [ 9 ]. In short, with this system, the 'clean' areas catered for patients without symptoms of infectious disease, whereas the 'dirty' areas are for those who have them.…”

“…This dual 'clean' and 'dirty' areas reflect the 'binary' term. For the 'dirty areas', there was also an isolation ward equipped with 14 negative pressure beds in the Emergency Department catering for patients who were COVID-19 positive [ 9 ].…”

“…The pandemic has forced the HKL hospital to practise a binary system that divided the Emergency Department into two identical areas: the dirty area for those having COVID-19 risk and the clean area for those having COVID-19 minimal risk. Each of these areas had red (critical), yellow (semi-critical) and green (non-critical) areas [ 9 ].…”

Impact of COVID-19 pandemic on STEMI thrombolysis and Emergency Department's performance in a non-PCI capable tertiary hospital

“…Each of these ‘clean’ and ‘dirty’ zones has red, yellow, and green segments that cater for patients based on illness severity. [ 3 ] This binary system can efficiently triage patients based on their symptoms at presentation and reduce the healthcare workers' exposure to COVID-19 [ 3 ]. On top of that, we observed numerically higher usage of tenecteplase during the pandemic.…”

“…This pandemic has caused crisis and collateral burden to the whole healthcare system, including the Cardiology services for ST-elevation myocardial infarction (STEMI) [ 1 , 2 ]. The healthcare system, including the Emergency Department (ED), has been reorganized to cope with the enormous surge of critically ill patients and prevent nosocomial COVID-19 transmission [ 2 , 3 ]. For instance, several tertiary public hospitals in Malaysia have been converted into hybrid hospitals that manage COVID-19 and non-COVID-19 patients.…”