Ms Huang Weili, Nurse Clinician, Children’s Emergency Department, KKH
When the DORSCON level was raised to orange on 7 February 2020, our team immediately moved to set up an Extended Screening Area (ESA) outside the Children’s Emergency (CE) at KK Women’s and Children’s Hospital, in preparation for an anticipated surge in patients.
The purpose of the ESA was to function as a separate extension catering to patients meeting the Ministry of Health (MOH) criteria indicating ‘intermediate risk’. Patients classified as ‘low risk’ would be directed into the main CE building, and those classified as ‘high risk’ would be directed to an isolation annexe off the main CE building. This plan was guided by our previous experiences during the H1N1 influenza outbreak in 2009, when it had proved useful in helping our team to effectively manage the situation then.
The ESA began operations that same weekend. As nursing supervisor, I began my shift in the new facility by briefing the nursing team on the new workflow. The first patient arrived at 8.00am, and by about 9.00am the patient waiting area in the ESA had reached maximum capacity. Patients continued to stream in, and some had to stand as there were not enough seats for everyone. Frustration levels began to rise, and it became increasingly difficult to maintain safe distancing between each unit of patient and caregiver. The situation on the ground threatened to become chaotic.
Under the layers of personal protective equipment, I could literally feel my body burning and perspiration pooling as I worked quickly with the team to manage the patient load. Thankfully, the situation in the ESA was being closely monitored, and additional nursing and medical staff were swiftly activated to attend to patients.
Exiting the ESA drenched in sweat, I approached my head of department to provide a situation report. We quickly realised that, unlike the H1N1 influenza outbreak in 2009, the majority of the patients presenting to CE this time were those meeting MOH criteria classified as ‘intermediate risk’, and the numbers of ‘low risk’ patients were extremely low. Hence, the smaller-scale ESA was being flooded with patients whilst the larger main CE building had fewer patients.
An urgent team discussion was held and the decision was swiftly made to switch the intermediate-risk and low-risk areas of the CE – and the patient flow. This resulted in the immediate easing of space constraints in the ESA and effective distribution of patients into the three main areas of the CE – a workflow which remains in place up till today.
As a nurse, my duty is to uphold the safety and well-being of not just my patients, but also my fellow teammates. Both duties are equally important. I am proud to work together with a responsive and dedicated team. Upon realising that what worked during the previous disease outbreak was not working for this COVID-19 situation, our team swiftly took action to find a solution to the issue, and keep everyone safe.