New Zealand Emergency Department COVID-19 Preparedness Survey

ABSTRACTObjectiveThis research sought to assess the level of COVID-19 preparedness of Emergency Departments (EDs) in Aotearoa New Zealand (NZ) through the views of Emergency Medicine specialists working in District Health Boards around the country. Given the limited experience NZ hospitals have had with SARS-CoV-2, a comparison of current local practice with recent literature from other countries identifying known weaknesses may help prevent future healthcare worker infections in NZ.MethodsA cross-sectional survey by convenience sample of New Zealand Emergency Specialists in November 2020 to evaluate preparedness of engineering, administrative policy, and PPE use.ResultsA total of 137 surveys were completed (32% response rate), revealing heterogeneity in NZ ED clinical work environments in November 2020. More than 10% of emergency specialists surveyed reported no access to negative pressure rooms. N95 fit testing was not done on 15 (11%). Most specialists (86%) work in EDs that cohort patients, about one-third (34%) do not use spotters during PPE doffing, few have policy regarding breaches in PPE, and most do not have required space for physical distancing in non-clinical areas. Initial PPE training, simulations and segregating patients were widespread but appear to be waning with persistent low SARS-CoV-2 prevalence. PPE shortages were not identified in NZ EDs, yet 13% of consultants did not indicate they would use respirators during aerosol generating procedures on COVID-19 patients. Treatment interventions including non-invasive ventilation and high flow nasal cannula were common. Many respondents reported high levels of stress attributable to predicted inadequate staffing and the state of overall preparedness in event of a second wave.ConclusionsNew Zealand emergency specialists identified significant gaps in COVID-19 preparedness, and they have a unique opportunity to translate lessons from other locations into local action. Proactive identification of weaknesses in hospital engineering, policy, and PPE practice in advance of future SARS-CoV-2 endemic transmission would be prudent.What is already known?Aotearoa New Zealand has eliminated COVID-19 community transmission. Recently, trans-Tasman neighbour Australia has controlled SARS-CoV-2 surges which were complicated by significant nosocomial spread and healthcare worker infections. Several recent publications as well as expert recommendations from the Australian Department of Health and Human Services have listed improvements to the Hierarchy of Controls necessary to prevent future outbreaks in hospitals and long-term care facilities.What are the new findings?Survey responses specifically identified breakdowns in engineering, administrative policy and PPE in New Zealand emergency departments (EDs), potentially increasing healthcare worker nosocomial infection risk. As of November 2020, equitable access of all NZ emergency specialists to recommended negative flow rooms, fit testing of N95 masks, and other evidence based policy upgrades to COVID-19 infection prevention and control (IPC) standards are not universal.What do the new findings imply?The experience of local emergency specialists in a rapidly evolving pandemic can identify weaknesses in emergency preparedness previously reported to have increased nosocomial infection risk in similar healthcare environments. The aim of this research was to identify those weaknesses in local NZ emergency department policy, protocols and PPE and further efforts to provide proactive recommendations for system improvement. Finally, the research sought to understand how safe NZ emergency specialists felt during the initial lockdown and provides insight as to the psychological experiences of this vital group of front-line staff.