Preparations of Dutch emergency departments for the COVID-19 pandemic: A questionnaire-based study

  1. Rory D. O’Connor
  2. Dennis G. Barten
  3. Gideon H. P. Latten

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Abstract

The onset of the COVID-19 pandemic was characterized by rapid increases in Emergency department (ED) patient visits. EDs required an appropriate transformation. The main challenges were: adapting capacity to respond to surges in the number of patient visits, protection of high risk (frontline) staff and the segregation of suspect-COVID-19 patients. To date, only a few studies have assessed the nation-wide response of EDs to the COVID-19 pandemic. This study was designed to review the preparations of Dutch EDs during the initial phase of this public health crisis.

Methods

The study was designed as a nation-wide, cross-sectional, questionnaire-based study of Dutch hospital organizations having one or more EDs. One respondent completed the questionnaire for each hospital. The questionnaire was conducted between the first and the second COVID-19 wave in the Netherlands. It contained close-ended and open-ended questions on changes in ED infrastructure, ED workforce adaptions and the role of emergency physicians (EPs) in each hospital crisis management team.

Results

The questionnaire was completed by 58 respondents. This represented 80% of the total number of EDs. All respondents had made preparations in anticipation of a COVID-19 patient surge. Treatment capacity was expanded in 70% of EDs, with a median increase of 49% (IQR 33–73%). Suspect-COVID-19 was segregated from non-COVID-19 patients in 89% of EDs. Alternative locations (such as outpatient departments) were more often used to assess non-COVID-19 patients, than for suspect-COVID-19 patients. Staff was expanded in 82% of EDs. This largely concerned nursing staff. A formal role for Emergency Physicians (EPs) in the hospital’s crisis management team was reported by 94% of hospital organizations employing EPs.

Conclusion

All Dutch EDs responded to the COVID-19 pandemic in a very short time span despite much uncertainty. Preparations predominantly concerned expansion of treatment capacity and segregation of COVID-19 ED care. EPs played a prominent role, both in direct COVID-19 care and in the hospital crises management team. It is vital for EDs to adapt to community needs swiftly. The ability of EDs to respond to the pandemic varied considerably.

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  1. Version published to 10.1371/journal.pone.0256982
  2. ScreenIT

    SciScore for 10.1101/2021.04.10.21254878: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIRB: 16 The Medical Ethics Committee Zuyderland & Zuyd concluded that the rules of the Medical Research Involving Human Subjects Act (WMO in Dutch) do not apply to this study (METCZ20200130).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analysis: All analyses were performed with SPSS version 26 (SPSS Inc., Chicago, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    The present study is not without limitations. First, this was a retrospective questionnaire-based study filled in by one respondent per ED, who may also have been the most involved professionals in crisis management in these EDs. Second, hospitals all around the world experienced reduced utilization of emergency services during the pandemic.20 This phenomenon, which is not yet completely understood, may have salvaged EDs which could have suffered from overcrowding without the reduction of non-COVID-19 ED care. In other words, the pandemic approaches of these EDs may not be as successful in other crisis situations. Finally, the results of this study may not apply to EDs in other healthcare systems, specifically systems without a strong primary care system functioning as gatekeepers for the hospitals.

    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 10.1101/2021.04.10.21254878v1 on medRxiv