Transforming the ED to Manage a Pandemic

Patricia Altman, MSN, RN, CEN, Chase Lodico, BSN, RN, CEN, MBA, Marites Gonzaga-Reardon, DNP, APRN, CCNS, CEN, Magdalena Nowakowski, BSN, RN, CEN, Galeta C. Clayton, MD

On March 9, 2020, a multidisciplinary team of ED physicians, nurses and leadership met to design the workflow and physical layout that would be needed in order to keep staff and patients safe in light of the impending COVID-19 pandemic.
Top Row: L. to R., Carolyn Clayton, Yanina Purim Shem-Tov, Thomas Alcorn, Dino Rumoro, Louis Hondros, Rene Carizey, Tes G. Reardon
Bottom Row: L. to R., Julie Panasik, Chase Lodico, Giles Slocum, Joshua DeMott, Kyle Wright, Renata McKim, Kevin Thomas, Anna Candoleza
Inset: Patricia Altman

On March 9, 2020, a multidisciplinary team of ED physicians, nurses and leadership met to design the workflow and physical layout that would be needed in order to keep staff and patients safe in light of the impending COVID-19 pandemic.

Through the help of patient-facing staff, leadership, and multiple other disciplines across the medical center, the team was able to transform the Emergency Department (ED) within one week.

The physical layout of the ED was changed to help isolate the patients with influenza-like illnesses (ILI) from the rest of the general patient population.

The ambulance bay was converted into a secondary triage area for the patients with ILI symptoms, and one of the pods in the ED was converted to a negative pressure treatment area for the safe treatment of these patients.

The staffing grid for both nursing and physicians was adjusted at this time to cover the new layout of the ED and allow for all of the new areas to remain functional at all hours of the day.

Workflow guidelines were developed for staff in all the different roles regarding both patients with or without ILI symptoms.

All these changes were made and disseminated to staff over a one-week period of time, starting our rollout during the second week of March.

This was only possible due to our previous LEAN-informed workflow changes over the past two years through the Continued Pursuit of Excellence (CPE). LEAN is a system of organizational principles that are used to maximize value and eliminate waste.

This empowers staff to make appropriate changes in patient care, with support from overseeing managers. The CPE framework, and the previous work which was done in the ED to aid in efficiencies, gave the team a structure from which to build upon when creating workflows, as well as sound communication techniques to interconnect and teach staff the newly designed plans. This work also inadvertently prepped the staff to be better equipped to handle the rapid change they would be asked to go through in the ensuing months.

ED census graph