Summary of key themes
| Theme | Challenges | Solutions |
| Departmental reconfiguration | Limitations created by the physical estates when ‘zoning’ the ED. | Use of Perspex screens. Temporarily using fire exits as ambulance entrances. Performing AGP delivery outside the ED where feasible. Relocating services away from ED. |
| Unpredictable number of ED attendances affecting departmental ‘zoning’. | Phased zoning informed by daily operational meetings. Mobile equipment trolleys. | |
| Patients with ‘incidental COVID-19’ being triaged to non-COVID-19 zones. | Screening chest radiographs. Increased use of CT chest. | |
| Clinical pathways | Developing clinical pathways for a novel condition. | Cohort patients into five groups according to observations and investigations. Early escalation of care decisions to facilitate patient cohorting. Mobile emergency rapid intubation teams to facilitate specialist airway management. |
| Workforce | Staffing an additional zone in ED, including ensuring appropriate senior cover. | Augment ED workforce with staff redeployed from other clinical areas. Review of rotas to extend senior cover. |
| Maintaining staff well-being and managing staff expectations. | Well-being hubs. Access to psychological support. Introduction of ‘NOVID’ and ‘wobble’ rooms. Rotating staff between zones. | |
| Governance and communication | Communicating frequently changing information. | Use of social media, messaging services and daily team briefings. Timing team briefings after daily operational meeting. |
| PPE | Staff anxiety around effectiveness of PPE. | Single source of information on PPE to aid communication. |
AGP, aerosol-generating procedure; PPE, personal protective equipment.