At the start of the COVID-19 crisis the Royal Melbourne Hospital (RMH) saw an influx in patients and had to quickly adapt to make sure the community could be safely tested and cared for.
The RMH is an adult tertiary referral centre and the designated state‐wide provider for quarantinable diseases. The emergency department (ED) treats over 80,000 patients annually.
The observations of the RMH rapid response has recently been published in The Medical Journal of Australia (MJA) to provide other hospitals background on the approach taken at the RMH during the early phases of COVID-19.
On 25 January, the first patient with COVID‐19 in Australia, who had arrived in Melbourne on a flight from Guangzhou, was confirmed.
This led to a significant surge in presentations to the RMH. It became clear very quickly a space was needed to accommodate the extra patients presenting for screening, making sure they could be socially distanced and separated from the rest of the patients presenting to the ED.
As the first surge of patients arrived over the Australia Day long weekend, the hospital repurposed the nearby transit lounge, which was closed for the weekend, into a fever clinic.
The clinic received its first patient within 2 hours of notification from DHHS of the first local case. In its first 7 days, the RMH assessed 109 patients. We discharged over 90% of patients within 4 hours of arrival.
The benefits of establishing a fever clinic included:
- Protecting an existing environment for the maintenance of business continuity;
- Facilitating protocolised interventions for spatially clustered groups of patients;
- Providing a physical location to send additional disaster resources without cluttering areas of core business; and
- Enhanced record‐keeping.
Associate Professor Mark Putland, Director of the RMH ED said the team were quick thinking and implemented the space and logistics for the screening clinic within 24 hours.
“By opening up the fever clinic so efficiently we had capacity to see hundreds of patients through screening safely, our staff were quick to adapt more than willing to go above and beyond to assist the hospital with the surge it was experiencing,” A/Prof Putland said.
The creation of an electronic self‐registration system also helped lift the burden placed on the administrative staff adapting to a number of challenges.
Dr Matin Dutch, Emergency consultant said the online system helped keep lines of patients moving as well as allowed less interaction time between clerks and patients to minimise transmission risk.
“We developed a novel solution to this problem, leveraging the fact that over 91% of Australian citizens and over 96% of Chinese citizens own a smartphone, and converted an initial paper‐based bilingual screening tool to an online one,” Dr Dutch said.
After patients were asked to answer a number of questions regarding their epidemiological risk and clinical risk factors, the results were fed straight back into the remote clinical computers where ward clerks could register the patient without any direct contact.
The rapid response of all staff and departments at the RMH is one example of the response across the whole state which ultimately gave the community confidence in the health care system to cope with the impending crisis.
“While the initial surge of patients has now subsided the hospital is in a good position to respond to any further increases in presentations for COVID-19,” A/Prof Putland said.