How EDs can institute workplace social distancing


  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • During the COVID-19 pandemic, a variety of measures can increase social distancing in the emergency department (ED), presumably without compromising care.

Why this matters

  • The ED is a potential SARS-CoV-2 transmission hotspot.

Key results

  • Main principles:
    • Reduce number of people in ED.
    • Minimize lengths of stay.
    • Minimize interpersonal contact.
  • Reducing transmission between workers:
    • As patient volume fell, ED reduced and staggered shifts and created larger backup staff pool.
    • Telemedicine consults rose.
    • Individuals reserved computers for a shift.
    • Signage discouraged staff gatherings.
    • Restaurants offering donations were asked to send individual meals.
  • Reducing transmission between workers and patients:
    • Rapid assessment areas outside ED.
    • Reduce number of examinations to 1, e.g., by resident while attending watches via video.
    • Nurses batched work to reduce number of entries to a patient’s room.
    • Use of bedside computers was discouraged.
    • Providers called or videoconferenced with patients in rooms when possible.
  • Leadership engaged in hands-on dissemination and real-time coaching by COVID-19 champions offering cafeteria coupons as incentives.
  • Provider infection rates have been "low" despite these EDs being hard-hit by pandemic.
  • Guidelines available as free 1-page document.

Study design

  • Description of social-distancing measures in Yale EDs.
  • Funding: None disclosed.

Limitations

  • Many measures must be rethought as patient volumes increase.