Frequently Asked Questions About Accessing the Emergency Department During COVID-19

Hello everyone. I'm Dr. Allison Gardner. I'm one of the pediatric emergency medicine faculty here at Brenner children's hospital with wake forest. And I'm here today with Dr. Megan Hunt. She's one of the adult emergency medicine providers. Um, and we're here to talk with you a little bit today, answer some questions about how the emergency department can be used or can best serve you during this time of the coven 19 pandemic cause we've gotten a lot of questions so we hope to use this time to answer. Um, some of the common ones that we've seen. Um, I see mainly kids in the pediatric emergency department here and Dr. Hunt sees mainly adults. Um, so we can each provider viewpoint on that. Well thanks again for joining us. I'm Dr. Megan Hunt and nice to meet you all. Um, today we're going to talk, one of the questions we got prior to this was is it safe to come to the ed and what precautions are being taken in the ed to protect against coven 19.

And I'm so glad we got this question. We have heard and we have found that people are not coming to the ed because they're worried about being safe and we have taken all of the measures we can think of to keep you safe. Initially when you arrive in our ed, you'll be met at the door by our screening team. They will be happy to provide you with the mask in case you're having symptoms and also check your temperature. They'll also be wearing masks to keep both you all the other patients they may see and themselves safe. The next thing that'll happen is if you have a visitor, we'll ask them to go back to their car. We'll be happy to help make sure you have the phone number for that person unless you truly have to have someone with you to be able to speak for you.

We, we allow exceptions in that case, but otherwise we're keeping visitors out of our hospital everywhere to make sure that we're reducing the number of people coming in that you could be exposed to. Once you enter the room or while you're in triaged. You'll notice that our triage nurses use gloves as well as mass, once again to keep you safe and to keep all the patients they see safe as well as themselves in the room. If we're evaluating you and particularly if you're having respiratory symptoms or fevers, you may see even more of the personal protective equipment that you've seen discussed on the news that can include gowns, goggles, masks, gloves and why that's on is to keep you safe, that keeps you safe, that keeps our team members safe. And the great news is our institution has done everything they can to make sure we have plenty of that equipment to be able to provide excellent quality care for you.

Those are just a few of the things that we've been doing to make sure that everyone can be safe while they're here. Um, and those are some of the precautions we've been taking in addition to making sure that we're operating in our spaces a little different than usual. Um, we do everything we can to keep folks who are having respiratory symptoms, fevers, infectious type symptoms in rooms with closed doors as well. So that we make sure that we're keeping all of that right in the room with the person who's experiencing it. Yeah, very, very true. Some of the, some of the majors that we've instituted to keep people safe are big engineering majors even that you won't even maybe notice or see. But different ways to have air flow through the department and through the rooms called negative pressure rooms that help keep viral particles to a minimum, um, and keep surrounding hallways and walkways safe.

We have way more hand, you know, hand washing stations everywhere, PRL stations everywhere. So you can feel free to use that and, and do what you know is commonly recommended. Wash hands or use the hand sanitizer as well as the mass and personal protective equipment that you'll see. Um, and, and dividing, uh, our emergency department up into different care spaces so that everybody's cared for in a very safe way. I will say that, um, if you have a child that needs to come to the emergency department, you are allowed to have two parents or two caregivers back, um, as well. So that's a nice thing. And we're trying to be as family friendly as possible. And you know, our nurses are so good. They're just, most of them are just pediatric emergency medicine nurses. They've been doing this a long time and have ways to use stickers and different ways to make it not so scary for your child.

Um, we've thought through kinda all that in the Brenner PTD for sure. Yeah. One thing that I wanted to talk to you about and we, we both are really excited to announce is, and in applies to this question, it says, I see that wake forest Baptist has virtual visits. Now are these visits as effective as an in person visit? And I can say definitely yes. This is, I think this is really exciting. We both worked really hard to get this up and going. Um, cause this is one of the first times that the emergency department has been allowed to do virtual visits. So, um, we have that in the PD area and in the adult area active now, um, you can call a phone number to access a video visit. Um, one common phone number for peeds and adult, and then it's one eight, four, four w F for wake forest, T, E L, E D.

So one eight, four for wake forest, tele ed. Um, and that'll, I'll give you some more information about where to find that later on our website. Um, but we have telehealth available, um, for both kids and adults. Like I said, you call that number and our registration person will get you to the right spot depending on what age needs to be seen. But our pediatric emergency medicine faculty are seeing kids via video visit and we can do a lot that way really a lot. And um, you know, it's helpful if you have a thermometer at home or some adults have some blood pressure cuffs at home. Um, our pulse oximetry home, whatever you have at home, we can really use to guide you. Um, we can use a parent's hands to help us feel on the belly or, um, you know, look in different places.

Um, we found a flashlight can be helpful too. So we're really learning a lot. We can do a lot through the, through the video. Um, the most important thing is I think that we can help identify whether this is something that needs to come in and get in person care. Um, you know, part of what we do obviously is treat emergencies. Um, cause we're emergency medicine doctors. But a lot of what we do is help parents and help people decide is this an emergency or not? Cause a lot of common things are, are just that common and can be cared for at home. But sometimes emergencies can mimic common condition. So, you know, as a parent you might be thinking, Oh, this might just be the usual constipation or, but, um, could this be appendicitis? And believe it or not, we can really help you decide that with a video visit and let you know, Hey, I really do think this might be appendicitis.

This timeline should come on in and we can talk about how to get here safely, tell you where to come, how to avoid, you know, waiting that kind of situation, be expecting you. So, um, yeah, they, they definitely are very useful. They're very, uh, helpful in the flow of things. Um, and I'm really excited to offer that. Yeah. Anything else I forgot there? Um, I don't think so. Um, we'll talk a little bit more about adults in that too. Uh, one of the other questions we got though was how do I decide when I need to be seen by a doctor in the emergency room? I'm worried about catching coven 19 especially if I have to wait a long time to be seen. So I'm really glad we got this question. And this is one of the ways where adult tele-health can really help. Um, you don't have to worry about catching coven 19.

I already talked about the safety measures we're taking, but additionally you can do this from the comfort of your own home anywhere in North Carolina. We can take a visit where we'll be able to have you come on, use the same number that Dr. Gardner mentioned before. When you call in registration per person, we'll connect you with either an adult provider or a paeds emergency medicine provider. Uh, when we talked to you, we're going to be talking to you. And the first and most important thing is going to be as if you're in the middle of having an emergency. So one of the questions was, how do I decide when to come to the emergency department? A lot of things haven't changed even though Cova 19 seems to have affected everything. If you're having chest pain where you're concerned you could have a heart attack, you need to come to the hospital right away.

And that's because that what we do for heart attacks. If you need to see a cardiologist or if you need to have a procedure done, the time that you show up determines how we can help you. The sooner you get here, the more we can help you. So we, if you're having a symptom like chest pain, we need you to come to the ed so we can help you with that. Also, if you're having symptoms of a stroke, if you're having facial weakness, changes in your speech, weakness of an extremity, all of those things, they would always make you call to come right away. Please come as soon as you have them. The earlier you get here, the more options we have to talk about with you as far as treatment, those things remain the same, but if otherwise you're not sure you're on the fence, you don't want to come because you're worried about it.

Please use this visit to help you make that decision. There's several outcomes of a telehealth visit. One, we may be able to talk to you and tell you, you know what, you can stay safe. You don't even have to come in. You can stay right where you are. If you need a prescription, we can work on calling that in for you. If you need to follow up with your regular doctor, if you need precautions for reasons to come back, we can provide all that to you and Dr. Gardner has even came up with a great idea of doing followup calls afterwards to check on you and see if perhaps you have nausea and we prescribe a medicine for that. We might be able to call you back in a couple of hours to make sure you're still able to eat and drink. If you're not at that point we might say, you know what, you probably do need to seek help from us.

Okay, so those are all things that we do. We could end the visit, we could say we think you need to actually come in to get care and if that's the case, we have network EDS across the region. So we have our high point regional medical center, Lexington medical center, Davie medical center and Wilkes medical center in addition to our Pisco church urgent care, which has Brenner's pediatric specialized training providers as well over in Greensboro. So all of those sites are available to you and at the end of your telehealth visit, if we recommend you go to one of those sites, we'll be happy to call ahead there to help facilitate care potentially even get things started with ordering some testing. If you're from the adult space or I'm working on calling ahead to see that we can get you in as quickly as possible waiting.

We have had very, very low weights because of people being safe at home. And this is another way for us to go ahead and assess what's your need so we will keep you safe when you come to see us and we can help you with that decision with video visits. Right, right. And I really do go that too. Some of these questions are very similar to that. I have, how do I know when a video visit is appropriate? When do I need to be seen in person? Um, that the same old rules apply for emergencies. You know, especially with children, we'll see a lot of respiratory issues. If you're, if you're really concerned your child's not breathing well or is um, maybe lethargic, not responding to you like normal, um, that kind of thing that just needs, you need to call nine 11 or come right in what you would normally do in that kind of situation.

But if it's a situation where like, Oh, I'm not sure, that's where we can definitely help you decide, should I go in or you know, should I stay at home and do home care? Um, we can definitely help with those decisions about is this something that needs to be taken care of in minutes, hours or over the next day or so. Um, I really liked the point to you that we, um, we have network hospitals all around us, so even if we recommend, you know, we might be leveled to recommend someplace closer to your home that you can go if you're not right here in Winston and in Greensboro. We do have, I'm just so proud of our Brenner urgent care. It's, it's the first urgent care, um, kind of under the department of emergency medicine. And the same providers that work in the emergency department also work out there.

They're very familiar with pediatric acute care and emergency medicine. So, you know, it might be that that's a convenient place for you to go based on our decision. It might be that we say, you know, you need to come into the emergency department or let's try this medication at home for vomiting or medication for asthma and we'll call back and check on you and see how it's going in an hour. So we definitely have mechanisms for all of those outcomes from a video visit and it, all of our sites, we are able to serve adults and pediatric patients at every single one of them. So, and that is, you know, that's kind of what we do is help people decide with acute illness and injury. Is this life threatening or not? That's that. That's what we do. So we want to be able and be available to you all during this time or you can reach us without having to physically come in if that's something you know you're not keen on doing.

Um, the last questions that we had was regarding if you've already been diagnosed with Cova 19 and you're worried complications, if you're starting to feel worse or having other concerns, can you schedule a video visit? Yes, you absolutely still can. And that helps keep you safe. It helps keep others safe that you want to avoid infecting as well. So we're happy. Again, like Dr. Garner said, if you're feeling too short of breath, if you're feeling tired, very weak, if you're concerned at all, please just come on into the evening and we'll take care of you. But if maybe you've seen your PCP that day or gotten the diagnosis and you're feeling a little unsure, maybe maybe your doctor's office is already closed. We're open till 10 o'clock at night, feel free to reach out to us and we'll be happy to reassess you and let you know.

We think it's okay for you to stay in place or we think maybe you should come into one of our hospitals and to help you with that decision so that you don't have to feel like you have to make it on your own. We're here to help you. I really liked that we have this available til 10:00 PM cause I don't know about you guys, but with myself, my symptoms always seem to get worse in the evening or my child's symptoms seems to get worse in the evening and so we're where they are in those evening hours. I think that's a great point. Yeah. Um, but, uh, and I just, I want to take a moment before we wrap up to thank everybody for, you know, doing their part in Winston and the surrounding area. Um, with social distancing and staying at home. You guys have helped us be safe and helped us better care for our community by doing that.

And I know it's tough. I'm squirreling myself sometimes staying at home, but I just want to thank everybody out there for doing that, that, that just means the world for us. So we're, we're, we're kind of separated right now trying to do our own social distancing here and be in a, be aware of that as well. Um, but I just think that's been really important and so a big thank you for that as well. Um, but at the same time, we also want to let you know that if you need care, let us help you. Um, access it, get it, let us help you advise that that's what we're here for. So that's why, you know, we really wanted to do this Facebook live today to get that message out. Um, so I think, you know, we can wrap up. Is that, yeah, the most common ones. We really want to thank you for joining us today. If you need more information, you can visit us@wakehealth.edu remember, we're here for you. We want to keep you safe, and we appreciate everything you're doing to help keep all of us safe with your social distancing and masking efforts as well. So thank you so much for joining Alison and I today.

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