New Zealand Emergency Department COVID-19 Preparedness Survey

  1. Michael J. Howard
  2. Charlotte Chambers
  3. Nicholas M. Mohr

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Abstract

Objective

Our objective was to assess the level of COVID-19 preparedness of emergency departments (EDs) in Aotearoa New Zealand (NZ) through the views of emergency medicine specialists working in district health boards around the country. Given the limited experience NZ hospitals have had with SARS-CoV-2, a comparison of current local practice with recent literature from other countries identifying known weaknesses may help prevent future healthcare worker infections in NZ.

Methods

We conducted a cross-sectional survey of NZ emergency specialists in November 2020 to evaluate preparedness of engineering, administrative policy, and personal protective equipment (PPE) use.

Results

A total of 137 surveys were completed (32% response rate). More than 10% of emergency specialists surveyed reported no access to negative pressure rooms. N95 fit testing had not been performed in 15 (12%) of respondents. Most specialists (77%) work in EDs that cohort COVID-19 patients, about one-third (34%) do not use spotters during PPE doffing, and most (87%) do not have required space for physical distancing in non-patient areas. Initial PPE training, simulations and segregating patients were widespread but appear to be waning with persistent low SARS-CoV-2 prevalence. PPE shortages were not identified in NZ EDs, yet 13% of consultants do not plan to use respirators during aerosol generating procedures on COVID-19 patients. Available treatments including non-invasive ventilation and high-flow nasal cannula were common.

Conclusions

New Zealand emergency specialists identified significant gaps in COVID-19 preparedness, and they have a unique opportunity to translate lessons from other locations into local action. These data provide insight into weaknesses in hospital engineering, policy, and PPE practice in advance of future SARS-CoV-2 endemic transmission.

Strengths and limitations of this study

  • Survey responses specifically identified existing breakdowns in engineering, administrative policy and personal protective equipment in New Zealand emergency departments, potentially increasing healthcare worker nosocomial infection risk upon reintroduction of SARS-CoV-2

  • Survey included emergency specialists from all 20 of New Zealand’s district health boards but the electronic convenience sample may not be representative of all ED consultants in NZ

  • Some survey questions asked respondents to recall experiences or project how they would practice if they were caring for a COVID-19 patient and those motivated to respond may feel they have more or less access to protective policies and equipment than non-respondents

Article activity feed

  1. Version published to 10.1101/2021.04.06.21253178v2 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2021.04.06.21253178: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study was considered exempt from the institutional review board by the NZ Health and Disabilities Ethics Committees.(26) The data analysis was primarily descriptive and reported as percentages of valid responses.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    As vaccination roll out accelerates, NZ will be monitoring uncertainties such as vaccine uptake, efficacy against variants, prevention of transmission, and vaccine safety in populations such as children and pregnant women.(15, 35) We hypothesize that the experience of individual Emergency Medicine specialists could be surveyed to identify weaknesses in local NZ hospital infection control practice. This questionnaire focuses on retrospective and prospective assessments by EM specialists of their departmental practice for pandemic specific engineering (ventilation, cohorting, streaming, physical distancing), administrative policy (rostering, workflow, training, treatments and procedures), and the use and supply of PPE (scenario specific, transmission based PPE, and fit testing).(13) Questions were translated from prior healthcare worker infection outbreaks, most notably from the Royal Melbourne Hospital campus during July-August 2020.(9, 12, 17) Finally, the research sought to understand how safe EM specialists felt during the initial lockdown and provides insight as to the psychological experiences of this vital group of frontline staff. Engineering controls decrease SARS-CoV-2 transmission by modifications to ventilation, bed allocation, streaming patients and physical distancing of staff. A minimum requirement would provide enough adequately ventilated and sealed negative pressure rooms, or at least negative directional airflow, to allow for treatment of respiratory isolatio...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.04.06.21253178v1 on medRxiv