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Marc Afilalo MD, MCFP(EM), CSPQ, FACEP, FRCP Professor and Chair, - PowerPoint PPT Presentation

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Marc Afilalo MD, MCFP(EM), CSPQ, FACEP, FRCP Professor and Chair, Department of Emergency Medicine, McGill University Director, Emergency Department Jewish General Hospital 1 What did we face in the 1 st wave ? Designated adult COVID hospital

  1. Marc Afilalo MD, MCFP(EM), CSPQ, FACEP, FRCP Professor and Chair, Department of Emergency Medicine, McGill University Director, Emergency Department Jewish General Hospital 1

  2. What did we face in the 1 st wave ? • Designated adult COVID hospital for half of Quebec • For direct admissions from other hospitals (wards and ICU) • 50 COVID pos and r/o visits in the ED per day 2

  3. March April May June July August N r/o Covid patients 1300 1600 1600 1700 1630 1700 N patients swabbed 831 1148 1274 1463 1542 1596 N positive PCR 138 256 148 50 22 17 % positive PCR 17% 22% 12% 3% 1% 1% 3

  4. Our ED Key Strengths: ED Culture Priority = Safety for all staff and patients • Culture of: • Unified proactive physicians' group • Co-management with nursing and Multidisciplinary teamwork • Communications 4

  5. Our ED Key Strengths: ED Design • 2 Hot pods • 32 individual cubicules • Excellent ventilation system • 10 negative pressure rooms • Resus • 5 cubicules • 5 negative pressure • 2 Cold areas • 1 pod of 16 individual cubicules, 1 negative pressure room • Ambulatory aera: RAZ and fast track 5

  6. Our ED Key Strengths: ED Staff • Strong commitment, buy-in and active participation • Schedule based on contingency plan • COVID MD 6

  7. Our ED Key Strengths: Contingency Plan • ED part • Hospital part: Ward beds: 240 / 170, ICU: 60 / 25 7

  8. Our ED Key Strengths: Policies & Protocols • Written by us, detailed, accessible • Strong negotiated collaboration with ID and ICP • Often ahead of Public Health 8

  9. Our ED Key Strengths: Operations & Flow • Screening nurse: 50 hot patients, 70 cold patients, down from 250 • Garage: 47, 29 to hot pods, 18 discharged • Resus: 3, 2 admissions • Hot pods: 29, 11 admissions • Buddy system • Cold areas 9

  10. Our ED Key Strengths: Others • PPE • Data driven • Simulation • Research 10

  11. February 17th Multidisciplinary nCoV JGH Tabletop Simulation -EMS, ED, ICU, Medicine, IPAC, Microbiology, ID, CIUSSS, DPS, Nursing, Ministry, Herzl Family practice/CRIU walk-in, Radiology, Security, Environmental Services 11

  12. Our Hospital Key Strengths • Full priority to COVID patients • IPC: Proactive • Daily COVID leaders' meetings • Nursing coverage • Admitting wards and ICU organization • Full testing lab 24/7 • Proactive PPE procurement • Excellent consultants' collaboration • Hospital Command Center 12

  13. ED Innovations • Telehealth • Intensive home care program • Hospital at home • Harmonization of care: POS 13

  14. Challenges of 1 st Wave • LTC tragedy, 20 to 40% of ED visits • COVID evidence-based knowledge • Public Health, MOH • COVID treatments and Vaccines • Well being • Visitors 14

  15. Challenges of 2nd Wave • When, how bad? • What will the cold patients' volume be • July and August: almost back to pre-COVID level • ED Capacity • Flu, G/E • Admitting bed capacity • Testing, serology, rapid saliva test • PPE • Risk factors score 15

  16. Conclusion 16

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