“[…] Our objective was to effectively set up an alternative system where we would be able to assure patient and staff safety in light of Covid-19 and also assure consistent service …”
The following was submitted to Wired868 by the North Central Regional Health Authority (NCRHA):
According to the chief executive officer of the North Central Regional Health Authority (NCRHA), Davlin Thomas, the NCRHA intends to ensure that patients and staff feel safe in the hospital environment and remain confident in the system, despite the changing global threat Covid-19 presents.
The team at NCRHA has been able to achieve this by demonstrating agility in a rapidly changing healthcare landscape and engaging empowering and disruptive innovations.
Clear delineation & modifying of process flow
Several systems have been put in place to eliminate the mixing of Covid and non-Covid patients. This is essential to ensure that patients with non-Covid complaints feel safe visiting the facilities of the RHA.
Several checkpoints have been set up at various strategic entry points in the hospital. These allow for the separation of patients with symptoms of Covid-19 and facilitate diversion into the parallel pathway.
The NCRHA has strict process flows to clearly delineate patients with symptoms of Covid versus regular patients. At the emergency departments, patients are clearly separated into Covid and non-Covid pathways. Doing this ensures that patients without suspicion of Covid-19 feel safe by reducing the possibility of exposure.
By clearly separating those suspected of Covid, while allowing staff and patients to feel safe.
As part of the innovation, NCRHA has made great strides in advancing tent facilities.
But these are more than just simple tents.
This facility, called the Fever, Cough and Cold Checkpoint, is fully outfitted with electrical and plumbing facilities. It has a fully stocked and functional resuscitation room equipped with a crash cart, oxygen and defibrillator. It also has private rooms and access to washroom facilities.
For staff safety, there is a dedicated doffing area, for the changing of PPE, as well as an industrial-grade swabbing booth to protect staff from becoming infected when testing for Covid-19. There are five sinks distributed throughout the space. Finally, the design is an open design, with zipped windows, which allows for unobstructed passage of air and aerosol dilution to mitigate nosocomial infection.
The tent facilities at the accident and emergency division (AED) is also adjoined to bathroom facilities and there are several readily available sinks to provide access to handwashing facilities, as well as fully functional sanitisation stations.
Tents have dedicated telephone access to facilitate communication with in-patient specialists, peripheral facilities and EMS.
Equipped with zipped windows to facilitate the dilution of aerosols and assist in the mitigation of transmission, the 40 x 50 tents are also quite spacious to ensure adequate social distancing, in observation of Covid-19 protocols. Patient care safety is of utmost importance to the NCRHA.
“Our objective was to effectively set up an alternative system where we would be able to assure patient and staff safety in light of Covid-19 and also assure consistent service … the noble segregation of potential Covid-19 patients and other ill patients people, which could only be facilitated by the hard work, endeavour and sacrifice of our nurses, doctors and all our medical staff, clerks, customer service representatives and patient escorts, who brave the frontline every day to protect this country.” CEO Thomas said.
“These health care workers, on a daily basis, are willing to forego risk to face the fire that is Covid-19 on behalf of people of Trinidad and Tobago. The tents form part of our systemic innovations to facilitate quality service to our people, which is at our core, is our primary function. Other than that, we would have to build whole new buildings, to accommodate the segregation,” the CEO continued.
According to NCRHA head of the accident and emergency department Dr Kiran Surage, the decision was taken to make certain that the already ill and vulnerable entering NCRHA facilities to access services were not mixing with possible Covid patients, while simultaneously creating mechanisms through which we could ensure that all our patients still had access to emergency services. As a result, some of the NCRHA emergency services have been filtered through tents.
NCRHA CEO added that the tents have been designed in a way that should a surge happen (Covid-19), with minimal modifications, it could be converted into a field hospital.
“If numbers were to exceed hospital capacity, we have an already operational lower level contingency plan,” Thomas stated.
In addition to the implementation of tents, the North Central Regional Health Authority (NCRHA) has also instated a telemedicine programme, through which the NCRHA delivered specialised care and consultation via telephone to over 1,000 patients weekly… all during the pandemic.
The NCRHA’s telemedicine programme, which was initially adopted during the first wave of Covid-19infections, was put in place to ensure that critical care was delivered to our chronic disease patients, particularly those with comorbidities that put them at a higher risk of contracting Covid-19, through the use of telecommunication technology.
Primary care doctors who normally deliver care in the health centres took up the mantle to call patients, do scheduled check-ups and offer consultation. The intention was and still is, to lower their risk and chance of exposure by not having them commute through or gather in public spaces while maintaining service priority.
Both the adult and paediatric emergency departments of the NCRHA have been equipped with Isopods. These are fully encapsulated devices that separate and protect both staff and patients. The devices are placed directly on the patient’s bed. It is equipped with a powerful filter that is well below the micron size of the Covid-19 virus.
No efforts have been spared with respect to make staff and patients feel safe.
“This is more than just duty, this is a crusade,” Thomas said.