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, - - PowerPoint PPT Presentation

May 21, 2023 39 likes •200 views

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

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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

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What did we face in the 1st 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

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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%

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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

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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

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Our ED Key Strengths: ED Staff

  • Strong commitment, buy-in and active participation
  • Schedule based on contingency plan
  • COVID MD

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Our ED Key Strengths: Contingency Plan

  • ED part
  • Hospital part: Ward beds: 240 / 170, ICU: 60 / 25

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Our ED Key Strengths: Policies & Protocols

  • Written by us, detailed, accessible
  • Strong negotiated collaboration with ID and ICP
  • Often ahead of Public Health

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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

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Our ED Key Strengths: Others

  • PPE
  • Data driven
  • Simulation
  • Research

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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

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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

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ED Innovations

  • Telehealth
  • Intensive home care program
  • Hospital at home
  • Harmonization of care: POS

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Challenges of 1st Wave

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

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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

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Conclusion

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