Journal Article

Impact of implementing an exclusively dedicated respiratory isolation room in a Brazilian tertiary emergency department

Camila de Miranda Cardoso, Maria, Pazin-Filho, Antonio, Lobo, Rômulo Rebouças, Romeo Boullosa, José Luiz, Neves, Fábio Fernandes, Vidal de Moura Negrini, Bento, Colleto, Francisco Antonio, Borges, Marcos Carvalho

2011

Overview

BackgroundOccupational risk due to airborne disease challenges healthcare institutions. Environmental measures are effective but their cost-effectiveness is still debatable and most of the capacity planning is based on occupational rates. Better indices to plan and evaluate capacity are needed.GoalTo evaluate the impact of installing an exclusively dedicated respiratory isolation room (EDRIR) in a tertiary emergency department (ED) determined by a time-to-reach-facility method.MethodsA group of patients in need of respiratory isolation were first identified—group I (2004; 29 patients; 44.1±3.4 years) and the occupational rate and time intervals (arrival to diagnosis, diagnosis to respiratory isolation indication and indication to effective isolation) were determined and it was estimated that adding an EDRIR would have a significant impact over the time to isolation. After implementing the EDRIR, a second group of patients was gathered in the same period of the year—group II (2007; 50 patients; 43.4±1.8 years) and demographic and functional parameters were recorded to evaluate time to isolation. Cox proportional hazard models adjusted for age, gender and inhospital respiratory isolation room availability were obtained.ResultsImplementing an EDRIR decreased the time from arrival to indication of respiratory isolation (27.5±9.3 × 3.7±2.0; p=0.0180) and from indication to effective respiratory isolation (13.3±3.0 × 2.94±1.06; p=0.003) but not the respiratory isolation duration and total hospital stay. The impact on crude isolation rates was very significant (8.9 × 75.4/100.000 patients; p<0.001). The HR for effective respiratory isolation was 26.8 (95% CI 7.42 to 96.9) p<0.001 greater for 2007.ConclusionImplementing an EDRIR in a tertiary ED significantly reduced the time to respiratory isolation.

• Publisher: BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine,BMJ Publishing Group LTD
• Subject: Adult / Brazil / Cardiac care / care systems / comparative system research / Customer services / Disease Transmission, Infectious - prevention & control / emergency care systems / emergency department / Emergency Service, Hospital - organization & administration / Female / hospital capacity / Hospitals / Humans / infectious diseases / Male / Medical personnel / Middle Aged / Occupational Exposure - prevention & control / occupational risk / operations management / Patient Isolation - methods / Proportional Hazards Models / queueing theory / Queuing theory / respiratory isolation rooms / Respiratory Tract Infections - prevention & control / Supermarkets / Time Factors / Tuberculosis / Variables