Evaluation of Emergency Department Surge Spaces During the COVID-19 Crisis

Background: In response to the surge of COVID-19 patients in March and April 2020, our emergency department in New York City implemented a novel triage screening process to identify low acuity patients who could be diverted from the emergency department to a surge space. Patients who were (1) ≤ 70 years old; (2) triaged as Emergency Severity Index category 4 or 5, and (3) not requiring use of a stretcher (4) displaying mild COVID-19 symptoms were diverted to one of two surge spaces [West Surge Space (WSS) or Ambulatory Clinic Surge Space (ACSS)], where a complete set of vital signs were taken and an exam by a medical provider was conducted.

Methods: From March 12 to April 20, 2020, we analyzed the total volume of patients diverted to the surge space and their discharge disposition (i.e., admitted to hospital, transfer to main emergency department, left against medical advice, discharged from a surge space, or expired). A receiver operator curve (ROC) was calculated to predict discharge disposition based on triage diversion to either surge space.

Results: There were 6,241 patients triaged during the study period, in which one-quarter [n = 1,753 (26%)] were diverted to a surge space. The average number of patients per day was 141.8 (standard deviation [SD] 54.5) in the main emergency department and 39.8 (SD 29.9) in the surge spaces. Of the patients triaged and diverted to a surge space, a large proportion were successfully discharged from those areas without entering the main emergency department (84%, n = 866 in WSS and 94%, n = 745 in ACSS). Very few signed out against medical advice (3%, n = 26 in WSS and 2%, n = 12 in ACSS), transferred to the main emergency department (1%, n = 8 in WSS and 0.4%, n = 3 in ACSS), or admitted (13%, n = 130 in WSS and 4%, n = 30 in ACSS]. No patients expired in either surge space. The ROC analysis showed that the model had excellent discrimination power, with an area under the curve of 0.97 for WSS and 0.96 for ACSS.

Conclusion: A novel triage screening process successfully diverted 26% of low acuity patients with mild symptoms of COVID-19 to surge spaces. Nearly 92% of these patients were successfully discharged without entering the main emergency department footprint.