Telemedicine in the acute care setting during the COVID-19 pandemic
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CE - LETTER TO THE EDITOR
Telemedicine in the acute care setting during the COVID‑19 pandemic Ziwei Lin1,2 · Tiong Beng Sim1,2,3 · Victor Yeok Kein Ong1,2,3 · Zulkarnain bin Ab Hamid1,2,3 · Weng Hoe Ho1,2,3 Received: 7 April 2020 / Accepted: 20 July 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Dear Editor, As of 10th July 2020, coronavirus disease 2019 (COVID-19) has afflicted 12,102,328 people and claimed 551,046 lives [1]. Transmission of the SARS-COV-2 virus to healthcare workers has been well documented and attributed to lack of personal protective equipment (PPE) and long duration of exposure to large numbers of infected patients [2]. Healthcare workers in the emergency department (ED) are frontline staff and are at increased risk of COVID-19 exposure and nosocomial infection. The use of telemedicine may mitigate this. We are a team running a 24-h urgent care centre (UCC) at Alexandra Hospital, a 215-bed general hospital in Singapore. To prevent spread of COVID-19 within the centre, an extended screening area (ESA) was constructed in a wellventilated sheltered area outside the main building. The ESA caters to patients with presentations suspicious for COVID19 such as respiratory complaints, fever, or contact history that increases their risk of exposure to the virus (e.g. contact with a known COVID-19 patient, had visited an area where a significant number of patients with COVID-19 were identified, etc.). The ESA comprises a doffing area, waiting area, triage area, consultation rooms, X-ray room, as well as an area for nasopharyngeal swabs to be obtained (Fig. 1). The waiting area consists of plastic chairs placed a minimum distance of 2.5 m apart to prevent transmission between patients. It has a maximum capacity of 20 patients. Patients are first screened by a security officer equipped with full PPE and * Ziwei Lin [email protected] 1
Emergency Medicine Department, National University Hospital, National University Health System, 9 Lower Kent Ridge Road, Singapore 119085, Singapore
2
Urgent Care Centre, Alexandra Hospital, National University Health System, Singapore, Singapore
3
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
then directed to the ESA if they meet any of the criteria listed above. Once in the ESA, they will be triaged by the nursing staff before being assigned to a specific seat to await consultation. Seat numbers are documented for contact tracing purposes in case the patient tests positive for COVID-19. A physician will enter the ESA to take a history from the patient and examine him/her before ordering investigations. After reviewing the results and deciding the disposition, the physician then re-enters the ESA to communicate this to the patient. Terminal cleaning is done after each patient encounter in the ESA. Prior to entering the ESA, healthcare workers don full PPE, comprising an N95 respirator, face shield or goggles, surgical cap, gown, and gloves. After exiting the ESA, healthcare worke
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