Efficacy of a four-tier infection response system in the emergency department during the coronavirus disease-2019 outbreak

INTRODUCTION: The coronavirus disease (COVID-19) pandemic has delayed the management of other serious medical conditions. This study presents an efficient method to prevent the degradation of the quality of diagnosis and treatment of other critical diseases during the pandemic. METHODS: We performed a retrospective observational study. The primary outcome was ED length of stay (ED LOS). The secondary outcomes were the door-to-balloon time in patients with suspected ST-segment elevation myocardial infarction and door-to-brain computed tomography time for patients with suspected stroke. The outcome measures were compared between patients who were treated in the red and orange zones designated as the changeable isolation unit and those who were treated in the non-isolation care unit. To control confounding factors, we performed propensity score matching, following which, outcomes were analyzed for non-inferiority. RESULTS: The mean ED LOS for hospitalized patients in the isolation and non-isolation care units were 406.5 min (standard deviation [SD], 237.9) and 360.2 min (SD, 226.4), respectively. The mean difference between the groups indicated non-inferiority of the isolation care unit (p = 0.037) but not in the patients discharged from the ED (p>0.999). The mean difference in the ED LOS for patients admitted to the ICU between the isolation and non-isolation care units was -22.0 min (p = 0.009). The mean difference in the door-to-brain computed tomography time between patients with suspected stroke in the isolation and non-isolation care units was 7.4 min for those with confirmed stroke (p = 0.013), and -20.1 min for those who were discharged (p = 0.012). The mean difference in the door-to-balloon time between patients who underwent coronary angiography in the isolation and non-isolation care units was -2.1 min (p<0.001). CONCLUSIONS: Appropriate and efficient handling of a properly planned ED plays a key role in improving the quality of medical care for other critical diseases during the COVID-19 outbreak.