WakeMed dismantles its COVID triage tents, but that doesn’t mean the outbreak is over
The coronavirus triage tents that WakeMed erected outside its three hospital emergency departments as the illness began to spread in late March were taken down on Monday, but hospital officials say it doesn’t mean the outbreak is over.
The portable emergency rooms for COVID-19 patients weren’t used as much as WakeMed expected when it set them up March 27. The number of confirmed cases in the United States had quadrupled that week, topping 100,000, and hospitals across North Carolina were bracing for a surge of patients like the one seen in New York in April.
When that didn’t happen here, hospitals used that breathing room to reconfigure their emergency departments and refine their procedures for treating patients with coronavirus symptoms. WakeMed no longer needs an isolated emergency department for COVID-19 patients outside the building, said Dr. Doug Trocinski, the medical director for the emergency department at WakeMed’s Raleigh campus.
“It gave us the opportunity over the last six or eight weeks to really get all our emergency departments set up to where essentially we have the same ability to separate folks with COVID-like symptoms and those without within our walls,” Trocinski said. “Which is obviously much better for everybody.”
Hospitals across North Carolina erected tents to keep patients with the flu-like symptoms of coronavirus from simply walking into their buildings and potentially infecting others. Some created fully equipped emergency departments, while others simply used the tents to screen and test patients.
Not all of the tents are coming down. As the state begins lifting restrictions that have closed businesses and kept people at home, UNC Health has decided to leave triage tents up outside Rex Hospital in Raleigh and UNC Medical Center in Chapel Hill, said spokesman Alan Wolf.
“Due to the Phase 1 reopening, we’ve elected to wait a bit longer to see whether there’s an uptick in positive patients,” Wolf wrote in an email. “We will reassess at the end of May.”
Duke Regional Hospital in Durham will take down its triage tent on Friday, according to Duke Health spokeswoman Sarah Avery. The tent at Duke Raleigh Hospital is used only for drive-thru testing by appointment and will remain up, Avery said.
Duke University Hospital’s drive-thru testing tent will remain up as well, Avery said, but the emergency department tent could be dismantled within the next two weeks if the volume of cases remains stable.
A mini-emergency department on a helipad
WakeMed set tents up outside its hospital in Cary and both hospitals in Raleigh. At WakeMed’s main campus on New Bern Avenue, a series of connected, climate-controlled tents created a 2,400-square-foot, 15-bed emergency department on a helipad about 50 yards from the building.
The first week the tents went up, they were staffed by about a half dozen nurses and technicians, as well as three physicians or other health care providers, Trocinski said. From an octagonal entryway, patients with minor symptoms were sent to one tent, while more seriously ill patients were sent to another. A separate tent was set aside for the most critically ill patients who needed ventilators or other treatments.
“The whole point is to try and keep folks that have these types of symptoms completely separated from people who don’t,” Trocinski said.
Now WakeMed has arranged its emergency departments and other parts of the hospitals to achieve the same thing, he said. WakeMed’s main emergency department has a separate 14-bed unit for people with respiratory illnesses, and another smaller unit with doors that close for patients with minor injuries, set apart from areas where trauma and other critically ill patients are treated.
Elsewhere in the hospital, all patients and visitors are screened when they enter, and lobbies and waiting areas have been reconfigured to enforce separation. Patients can now register before they arrive or avoid a physical visit altogether by speaking with a doctor or other health care provider by computer.
The goal, hospital administrators say, is to make people feel comfortable seeking care for non-COVID-19 illnesses such as heart problems, strokes or appendicitis that can become serious without prompt attention.
“We all understand the fear; we live with it as well,” Trocinski said. “We just want people to understand that this is a very safe environment. In fact, it may be safer than it ever has been, because of the new procedures, the cleaning, the separation and segmentation.”
The COVID-19 triage tents weren’t used long at WakeMed. After about a week, it became clear that the hospital could handle the coronavirus patients inside the building, Trocinski said. He says the WakeMed system has treated between 25 and 35 COVID-19 patients at a time in recent weeks and never had more than 40.
He and leaders at other hospitals credit the stay-at-home orders and other sacrifices people have made to reduce the spread of the virus with keeping those numbers relatively low.
But until there’s a vaccine or the population develops widespread immunity, coronavirus will continue to circulate and could flare up again. WakeMed has begun thinking about how to handle coronavirus during next winter’s cold and flu season, Trocinski said.
And the tents won’t be far. If he needs to create a 15-bed emergency room out on the helipad again, or somewhere else, Trocinski says the experience this spring showed him that WakeMed can have it ready to go in five hours.
“It gave us a lot of confidence if we do need to put them back up, be it in July, or be it next fall or be it for a hurricane or whatever we need,” he said. “We learned a great deal on how to manage emergency departments outside of those walls.”
This story was originally published May 11, 2020 at 2:53 PM with the headline "WakeMed dismantles its COVID triage tents, but that doesn’t mean the outbreak is over."
