New Zealand Emergency Department COVID-19 Preparedness Survey

Objective

Our objective was 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.

Methods

We conducted a cross-sectional survey of NZ emergency specialists in November 2020 to evaluate preparedness of engineering, administrative policy, and personal protective equipment (PPE) use.

Results

A total of 137 surveys were completed (32% response rate). More than 10% of emergency specialists surveyed reported no access to negative pressure rooms. N95 fit testing had not been performed in 15 (12%) of respondents. Most specialists (77%) work in EDs that cohort COVID-19 patients, about one-third (34%) do not use spotters during PPE doffing, and most (87%) do not have required space for physical distancing in non-patient 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 do not plan to use respirators during aerosol generating procedures on COVID-19 patients. Available treatments including non-invasive ventilation and high-flow nasal cannula were common.

Conclusions

New 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. These data provide insight into weaknesses in hospital engineering, policy, and PPE practice in advance of future SARS-CoV-2 endemic transmission.

Strengths and limitations of this study

• Survey responses specifically identified existing breakdowns in engineering, administrative policy and personal protective equipment in New Zealand emergency departments, potentially increasing healthcare worker nosocomial infection risk upon reintroduction of SARS-CoV-2

• Survey included emergency specialists from all 20 of New Zealand’s district health boards but the electronic convenience sample may not be representative of all ED consultants in NZ

• Some survey questions asked respondents to recall experiences or project how they would practice if they were caring for a COVID-19 patient and those motivated to respond may feel they have more or less access to protective policies and equipment than non-respondents