Table 1

Challenges faced by the COVID-19 pandemic and the solutions offered by the ITA

ChallengeSolution offered by the ITA and departmental change
Possible high patient volumesIncrease ED capacity to include adjacent AMU as an area to assess patients.
Need for COVID-19 and non-COVID-19 streams with varying levels of careEffective triage by the ITA into defined COVID-19 and non-COVID-19 areas for both critical and routine care.
Potential to spread infection when transferring a patient with suspected COVID-19 infectionThe ITA is situated in the ambulance bay, therefore decision making about patients’ potential of infection occurs before they enter the hospital. Patients are streamed to appropriate inpatient COVID-19 areas if suspected they will need inpatient stay. Transfer to the wards from resus/COVID-19 assessment area is possible directly through ITA, therefore avoiding non-COVID-19 zones. Patient handover is via telephone, reducing risk to teams entering new clinical areas.
Risk of exposure to potential infection for triage staffTriage situated outdoors in the ambulance bay, using assessment in and around ambulances while using basic personal protective equipment (PPE).
Risk of delays in treatment of unwell COVID-19 patientsThe assessing clinician in the ITA immediately establishes the risk of severe illness in patients, and so can initiate early interventions in patients suspected to be with COVID-19 on arrival. This is done in a ‘rapid assessment and triage’ approach7 by a senior clinician, as evidence has shown that early investigation and treatment of the unwell patient can improve patient outcome and flow.8 9
Staff moving between clinical areas leading to potential spread or contaminationThere are specific donning/doffing areas separated by doors between COVID-19 resus and non-COVID majors through which staff must pass to move between each clinical area (see figure 1). This means these two areas remain isolated from each other.
COVID-19 resus, COVID-19 assessment area and COVID-19 majors are all isolated with closed doors between them and the other clinical areas. Staff must don appropriate PPE before entering any of these areas and doff on leaving. Full PPE is worn in COVID-19 resus with basic PPE worn in all other zones.6
Patients with COVID-19 potentially presenting with atypical or subtle featuresSmall groups of experienced staff triage high volumes of patients and use an audit feedback system to inform decisions. Prehospital and triage observations are used in decision making.
  • AMU, acute medical unit ; ITA, incident triage area .