PT  - JOURNAL ARTICLE
AU  - Ronald Ming Ren Tan
AU  - Gene Yong-Kwang Ong
AU  - Shu-Ling Chong
AU  - Sashikumar Ganapathy
AU  - Arif Tyebally
AU  - Khai Pin Lee
TI  - Dynamic adaptation to COVID-19 in a Singapore paediatric emergency department
AID  - 10.1136/emermed-2020-209634
DP  - 2020 May 01
TA  - Emergency Medicine Journal
PG  - 252--254
VI  - 37
IP  - 5
4099  - http://emj.bmj.com/content/37/5/252.short
4100  - http://emj.bmj.com/content/37/5/252.full
SO  - Emerg Med J2020 May 01; 37
AB  - 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.