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At December 2019, viral pneumonia cases were reported due to novel Coronavirus SARS-CoV-2 in Wuhan, China.1That viral disease has become a world-wide pandemic and affected nearly 1.2 billions of people on earth. Number of deaths related with the COVID-19 is more than 60.000 after 4 April 2020.2
The most important effect of COVID-19 on the health system was crowdedness of EDs. Alot of anxious patients had problems to reach a healthcare professional. Increment of the demand of outpatient presentation caused difficulties in the health systems. The frontline workers almostly tried to make a rapid and accurate triage at the beginning, then we have become more and more experienced each day. Criteria and guidelines both for diagnosis and treatment have been changing each day, so we all need to follow the latest guidelines and high quality reports.3
The second problem is to protect the COVID-19 negative patients and healthcare staff from the infected patients. It is important to isolate the infected or suspect patients immidiately at isolated areas.
Adana City Research & Education Hospital is the biggest hospital of the region with with nearly 2000 beds. Daily 150 ambulance and and a total of 1500 patients present to the ED each day, which was settled on 3 thousand meters square area. There are 28 emergency physicians and 34 emergency residents working in the ED. We constructed a COVID-19 hospital council and decided to re-design the ED for up-coming COVID-19 presentations after the WHO pandemic annoucement. We moved the ambulance enterance into the main outpatient enterance first and we built a COVID-19 unit on that area (previous ambulance enterance) which includes a computed tomography. There are three outpatient COVID-19 clinics at the enterance and one seperated room for suspect COVID-19 patients brought with ambulance. We are taking the naso-oropharyngeal swab in these clinics and patients undergo CT evaluation here. At the end of the corridor, there is monitored unit to follow up COVID-19 suspect patients with 12 beds. There are also 3 rooms for stable suspect COVID-19 patients. The hospital COVID-19 council seperated the full block for COVID-19 patients which is above the ED. We have a seperated COVID-19 area elevator for taking patients to the ICUs and inpatient clinics at the same block. There are about 400 beds at this block including ICU beds. On the other hand, we evaluated the non-COVID-19 patients, both ambulance and outpatients, at the protected area. There is an ambulance enterance and two triage rooms managed by senior nurses. After the triage, patients are examined by the residents at the examination area. Then these patients are followed up at monitored or non-monitored units (Figure 1). The ambulance brings the patient directly to the monitored observation unit and is being met by an emergency physician.
We settled a frontline triage in front of the normal enterance. All outpatients first are met here by a nurse here. The nurse is checking for temperature and the main complaint of the patients...
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- Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet Lond Engl 2020;395:507–13. doi:10.1016/S0140-6736(20)30211-7
- Johns Hopkins Coronavirus Resource Center. Johns Hopkins Coronavirus Resour. Cent. https://coronavirus.jhu.edu/ (accessed 4 Apr 2020).
- Yubin Cao, Qin Li B, Jing Chen B. Hospital Emergency Management Plan During the COVID-19‐19 Epidemic. Acad Emer Med. March 2020 https://doi.org/10.1111/acem.13951.