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Dynamic adaptation to COVID-19 in a Singapore paediatric emergency department
  1. Ronald Ming Ren Tan1,2,
  2. Gene Yong-Kwang Ong1,2,
  3. Shu-Ling Chong1,2,
  4. Sashikumar Ganapathy1,2,
  5. Arif Tyebally1,2,
  6. Khai Pin Lee1,2
  1. 1 Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
  2. 2 Duke-NUS Medical School, Singapore
  1. Correspondence to Dr Ronald Ming Ren Tan, Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore; Ronald.tan.m.r{at}


Singapore was one of the earliest countries affected by the coronavirus disease 2019 (COVID-19) pandemic, with more laboratory-confirmed COVID-19 cases in early February 2020 than any other country outside China. This short report is a narrative review of our tertiary paediatric emergency department (ED) perspective and experience managing the evolving outbreak situation. Logistic considerations included the segregation of the ED into physically separate high-risk, intermediate-risk and low-risk areas, with risk-adapted use of personal protective equipment (PPE) for healthcare personnel in each ED area. Workflow considerations included the progressive introduction of outpatient COVID-19 testing in the ED for enhanced surveillance; adapting the admissions process particularly for high-risk and intermediate-risk cases; and the management of unwell accompanying adult caregivers. Manpower considerations included the reorganisation of medical manpower into modular teams to mitigate the risk of hospital transmission of COVID-19. Future plans for a tiered isolation facility should include structural modifications for the permanent isolation facility such as anterooms for PPE donning/doffing; replication of key ED functions in the tent facility such as a separate resuscitation room and portable X-ray room; and refresher PPE training. Dynamic reassessment of ED workflow processes, in conjunction with the hospital and national public health response, may help in managing this novel disease entity.

  • paediatrics, paediatric emergency medicine
  • infectious diseases

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  • Contributors All authors have made substantial contributions to the study conception and design. RMRT wrote the first manuscript draft and all authors contributed to revising it critically for important intellectual content, as well as final approval for the version to be submitted.

  • 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 Dr Gene Yong-Kwang Ong is Decision Editor, Emergency Medicine Journal.

  • Patient and public involvement statement It was not appropriate or possible to involve patients or the public in the design, or conduct, or reporting, or dissemination plans of our research.

  • Patient consent for publication Not required.

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