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Impact of implementing an exclusively dedicated respiratory isolation room in a Brazilian tertiary emergency department
  1. Rômulo Rebouças Lobo1,
  2. Marcos Carvalho Borges3,
  3. Fábio Fernandes Neves2,
  4. Bento Vidal de Moura Negrini1,
  5. Francisco Antonio Colleto1,
  6. José Luiz Romeo Boullosa1,
  7. Maria Camila de Miranda Cardoso1,
  8. Antonio Pazin-Filho3
  1. 1University Hospital of the Medical School of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil
  2. 2Department of Medicine, University of Sao Carlos, Sao Paulo, Brazil
  3. 3Medical School of Ribeirão Preto, University of Sao Paulo, Sao Paulo, Brazil
  1. Correspondence to Dr Antonio Pazin-Filho, Departamento de Clínica Médica, FMRP-USP, Centro de Estudos de Emergências em Saúde – CEES, R. Bernardino de Campos, 1000 Ribeirão Preto–SP 14015-030, São Paulo, Brazil; apazin{at}fmrp.usp.br

Abstract

Background Occupational risk due to airborne disease challenges healthcare institutions. Environmental measures are effective but their cost-effectiveness is still debatable and most of the capacity planning is based on occupational rates. Better indices to plan and evaluate capacity are needed.

Goal To evaluate the impact of installing an exclusively dedicated respiratory isolation room (EDRIR) in a tertiary emergency department (ED) determined by a time-to-reach-facility method.

Methods A group of patients in need of respiratory isolation were first identified—group I (2004; 29 patients; 44.1±3.4 years) and the occupational rate and time intervals (arrival to diagnosis, diagnosis to respiratory isolation indication and indication to effective isolation) were determined and it was estimated that adding an EDRIR would have a significant impact over the time to isolation. After implementing the EDRIR, a second group of patients was gathered in the same period of the year—group II (2007; 50 patients; 43.4±1.8 years) and demographic and functional parameters were recorded to evaluate time to isolation. Cox proportional hazard models adjusted for age, gender and inhospital respiratory isolation room availability were obtained.

Results Implementing an EDRIR decreased the time from arrival to indication of respiratory isolation (27.5±9.3 × 3.7±2.0; p=0.0180) and from indication to effective respiratory isolation (13.3±3.0 × 2.94±1.06; p=0.003) but not the respiratory isolation duration and total hospital stay. The impact on crude isolation rates was very significant (8.9 × 75.4/100.000 patients; p<0.001). The HR for effective respiratory isolation was 26.8 (95% CI 7.42 to 96.9) p<0.001 greater for 2007.

Conclusion Implementing an EDRIR in a tertiary ED significantly reduced the time to respiratory isolation.

  • Cardiac care
  • care systems
  • comparative system research
  • emergency care systems
  • emergency department
  • hospital capacity
  • infectious diseases
  • occupational risk
  • operations management
  • queueing theory
  • respiratory isolation rooms
  • tuberculosis

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Ethical Comittee of the University Hospital of the Faculty of Medicine of Ribeirão Preto of the University of São Paulo.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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