Article Text

Download PDFPDF
Crisis clinical pathway for COVID-19
  1. Edward Hyun Suh1,
  2. David J Bodnar2,
  3. Laura D Melville3,
  4. Manish Sharma4,
  5. Brenna M Farmer2
  1. 1 Department of Emergency Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA
  2. 2 Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
  3. 3 Department of Emergency Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA
  4. 4 Department of Emergency Medicine, NewYork-Presbyterian Queens, Flushing, New York, USA
  1. Correspondence to Dr Edward Hyun Suh, Emergency Medicine, Columbia University Medical Center, New York, NY 10032, USA; ehs2109{at}


The pandemic of COVID-19 has been particularly severe in the New York City area, which has had one of the highest concentrations of cases in the USA. In March 2020, the EDs of New York-Presbyterian Hospital, a 10-hospital health system in the region, began to experience a rapid surge in patients with COVID-19 symptoms. Emergency physicians were faced with a disease that they knew little about that quickly overwhelmed resources. A significant amount of attention has been placed on the problem of limited supply of ventilators and intensive care beds for critically ill patients in the setting of the ongoing global pandemic. Relatively less has been given to the issue that precedes it: the demand on resources posed by patients who are not yet critically ill but are unwell enough to seek care in the ED. We describe here how at one institution, a cross-campus ED physician working group produced a care pathway to guide clinicians and ensure the fair and effective allocation of resources in the setting of the developing public health crisis. This ‘crisis clinical pathway’ focused on using clinical evaluation for medical decision making and maximising benefit to patients throughout the system.

  • emergency department operations
  • disaster planning and response
  • guidelines
  • infectious diseases
  • major incidents
  • epidemiology

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Ellen J Weber

  • Contributors All authors were members of the working group that developed the pathway. EHS wrote the draft of the manuscript. BMF led the group and contributed substantially to the draft. DJB, LDM and MS all made significant contribution to edits and revisions of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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