|Title:||How do you manage a respiratory pandemic in a hospital with an emergency department but no critical care? One DGH’s experience|
|Author(s):||M McCall C Hagan A Livingstone S Moan|
|Institution:||Daisy Hill Hospital|
|Poster:||Click to view poster|
|Abstract:||How do you manage a respiratory pandemic in a hospital with an emergency department but no critical care? One DGH’s experience |
M. McCall, C Hagan, A Livingstone, S. Moan, E. Hayes,
Department of Respiratory Medicine, Daisy Hill Hospital, Newry, Southern Health & Social Care Trust
D. McNicholl, A Green
Department of Respiratory Medicine, Craigavon Area Hospital, Craigavon, Southern Health & Social care trust
The COVID-19 pandemic has generated huge numbers of patients requiring hospital admission for supplemental oxygen therapy. A significant proportion of these patients will go on to require critical care input and advanced oxygen delivery techniques such as continuous positive airways pressure (CPAP), non-invasive (NIV) or invasive mechanical ventilation (IMV).
Often these patients deteriorate early and quickly, this poses challenges in regard to ensuring these patients are managed in appropriate care areas, this is a particular challenge when the emergency department and critical care are not located within the same hospital site.
In this situation we developed a protocol for guiding the management of these patients depending upon the patient’s escalation status, their ceiling of treatment and their current level of hypoxemia measured objectively by the PF ratio.
This protocol is then used to guide patients into one of four groups
• Best supportive care, remaining in DGH
• Active care up to and including NIV remaining in DGH
• Active care up to and including IMV, P/F >25, remains in DGH and monitored
• Active care up to and including IMV, P/F <25, Transferred to local hospital with ICU available.
We believe this protocol has functioned well and would be of interest to the Irish respiratory community which is comprised of many small DGH hospitals in a similar situation.