The Emergency Department prepares for a marathon, not a sprint during COVID-19 pandemic

When images of overwhelmed Emergency Departments began to appear on the news our ED team began to worry about the predicted surge of COVID-19 cases here at the Guelph General Hospital. What happened next was the largest overhaul of processes, procedures, and protocols ever undertaken. The ED space was reviewed with the lens of trying to provide exceptional ED care, while ensuring the safety of staff and patients in a very crowded environment. Nothing was sacred, every single step for every possible procedure was questioned. They quickly-formed a COVID-19 Committee of staff from the ED and a representative from the Hospitalist group. This committee met for hours every week reviewing the Ministry of Health clinical guidance documents to discuss and plan for the fast-emerging pandemic. This planning was shared with our Hospital teams and care partners, like ICU and the Guelph-Wellington Paramedic Service, and mock scenarios were practiced to perfect the teamwork needed to ensure everyone’s safety. The ED was reconfigured to have a COVID and a non-COVID zone to minimize exposure and to conserve precious PPE.

Another major change was the creation of two negative pressure isolation spaces for resuscitations. These areas are specially designed to support procedures that are ‘aerosol generating’ such as intubation patients and ventilating patients. The caregivers in these rooms had to develop methods for communicating through face shields with those on the other side of the glassed walls. ED developed standard orders and created large white boards that could easily be read from either side of the glass. They also used baby monitors to help with communications between rooms.

The initial fear of not having an adequate supply of N95 masks, goggles, face shields, gowns and gloves created a lot of anxiety for the team.

Practicing and perfecting donning and doffing technique became even more of a focus for the department and many staff members began showering down at the Hospital at the end of their shift to avoid potentially bringing the virus home to their families.

The ED team is incredibly thankful for all of the community members who donated PPE and supplies. This helped to alleviate their fears and offered reassurance that the community was standing strong with them during challenging times.

The Hospital’s no visitor policy during the early phase of the pandemic worked to help keep people safe but it created a challenge for ED. Tough conversations with patient’s loved ones had to occur over the phone. Communication with patients was hampered as well with both parties wearing procedure masks and not being able to see each other’s expressions. For older patients with hearing loss there was no ability for them to lip read or even see a caregiver’s smile.

Luckily for Guelph and Wellington County our ED was not overwhelmed with patients during the initial phase of the pandemic. In fact, our doctors were concerned that people having heart attacks and strokes may have hesitated to come in, potentially causing themselves long-term health issues. People who may have come to the ED automatically before, now explored the after-hours and virtual care options at their family doctor’s office instead.

By October we could be dealing with a second wave of COVID-19 intermingled with the seasonal flu. To get ready, ED will be expanding its very cramped quarters by using a large trailer that will be installed in front of the Hospital. The trailer will add much needed intake space so we can use the clinical area more efficiently and safely for patient care. This work will be occurring over the summer and fall to be ready for flu season this year.

This exhaustive pandemic planning process undertaken by the ED team has led to an enhanced feeling of cohesiveness among staff. ED staff report extra appreciation for their ‘colleagues in care’, such as clerks, porters, social workers, environmental services, lab, respiratory therapy, diagnostic imaging and the mental health team who helped them get patients seen and cared for in a timely and safe way. Communicating regularly at huddles for the Porters and for Environmental Services kept everybody in the loop.

The fantastic teamwork and intense planning by our Emergency Department is a source of pride for us at Guelph General Hospital. We need this team to be strong, prepared and at the ready to keep our community safe. We know this is a marathon, not a sprint, and we are pacing ourselves in order to be there to serve you the whole way through.

This story originated on Guelph General Hospital’s Facebook page on August 4th, 2020 as part of its #behindthemask series to share how the Hospital is working hard to protect patients and visitors from #COVID19.