Emergency: “It Feels Like a Different Hospital”

Since this article was originally published, the Emergency Department has seen increased daily patient volumes and hospital occupancy rates, and continues to adapt to the COVID-19 environment. The article below should be read as a snapshot of ED experience in April.


 

It feels like a different hospital.

That was Dr. Elizabeth Shouldice’s first thought when she got out of her car for her first shift back in QCH’s emergency department (ED).

A family vacation before the lockdown meant that she had been in isolation at home while QCH geared up to tackle the COVID-19 outbreak. And now nothing felt familiar.

“Queensway is my work-home, it’s where I feel comfortable,” explained Dr. Shouldice, who has been an ED physician at QCH since 2008. “But when I got out of my car for my first shift it felt so different.

“Having to check-in and collect hospital issued scrubs, change my clothes, figure out how I was going to get home and keep my family safe when I get home. All those anxieties were really heavy, and it made it more exhausting to gear-up to just get to work.”

Weeks before the first COVID-19 patient walked through the front doors, the ED team was ramping up procedures and precautions to ensure they were ready to meet them.

“The team was nervous, but prepared,” explained Dr. Bhaskar Gopalan, Chief & Medical Director, Emergency Services. “We’d been planning for weeks. We had a COVID-specific zone ready so that patients could be seen in a separate area by staff who had the appropriate PPE, and we have a negative pressure room ready in case we had to perform an aerosol-generating procedure.

“We’ve also worked closely with our friends in the Intensive Care Unit (ICU) to run simulations for our staff – and to provide videos of the simulations to our frontline nurses.”

It was a lot of information for staff to take in. A lot of new protocols and processes. And they were changing on a daily basis in the early days of the outbreak.

Planning. Education. Practice. Wait.

It’s a dilemma that’s playing out in hospitals across the globe – the weeks of preparation followed by a period of waiting for the shoe to drop. And that can put even more pressure on the frontline team.

The team has been resilient and engaged, and really doing an amazing job,” stressed Pam Ladouceur, nurse manager in ED, when asked about COVID-19. “But it’s hard to look back on it now because we still feel like we’re still stuck in the weeds – we’re dealing with more time idling than we’re used to, and that time was being filled with fear of what could be coming.”

It’s a sentiment echoed by Dr. Shouldice.

“A lot of the fear is uncertainty,” Dr. Shouldice stressed. “Are we going to become like NYC? Are we going to become like the next Italy?

“I don’t think so – I think Canada has done a good job – but what’s going to happen to our patients in Long Term Care (LTC)?”

It’s a fear that’s echoed by Dr. Gopalan.

“The team is nervous but at the same time prepared if the volumes go up,” he explained. “There was a lot of anxiety about PPE numbers and the different PPE requirements for different scenarios. And it’s not unique to our hospital – the education and PPE protocols keep changing and we’ve had to adapt on the fly to some of these changes. And that can sometimes cause a little confusion.”

There are fears that Dr. Shouldice thinks will forever alter how the QCH staff will approach how they work – the way SARS affected the staff who worked through it.

Things will never be exactly as before.

She recalls an incident early in her career when a co-worker mentioned that they had stopped wearing outside shoes to the hospital following SARS.

“Our former Chief Dr. John Earl, said he had been wearing scrubs ever since SARS because his wife started asking him to change before coming home,” she continued. “At the time, all that seemed so foreign to me, but now it’s coming full circle because it’s what we’re having to do now.”

And it’s shed some light on the work her coworkers in Infection Prevention and Control (IPAC) do – as well as a new outlook on how she manages PPE in general.

“It was easy pre-COVID to be frustrated by some infection prevention and control measures,” Dr. Shouldice explained. She highlighted the frustration of having to Don and Doff PPE to re-enter rooms with patients on Contact protocols – an extra step that just slowed down care. “But I think I now have an appreciation of what they’ve done to keep us safe. There’s such a trust we’ve put into that team, and they’ve done so much work to make sure that we’re safe.”

And the PPE?

“I think I’ll never again take for granted those boxes of masks on the wall!” she laughed. “Someone said they remembered the days they accidentally took three gloves out of the box instead of two, and just put one in the garbage like they’re some sort of glove billionaire!

“It’s given me a lot of perspective on those supplies that you just take advantage of because you think they’ll always be there.”

Changes still to come.

But there’s no sense of complacency in ED as the number of cases in recent weeks have stabilized. The department is still adapting to COVID-19 – changing the layout to adapt to the virus, procedures and protocols for Code Blues, and working more closely with other departments like ICU and Anesthesia to adapt their patient care.

With the focus of COVID care focusing on long-term care homes, there’s more of that adaptation to come.

“This team is willing to change direction in an instant – they’ve had to do so many times already,” Pam stressed. “And they’re poised to do it again when the time comes.”

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