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Objective: To assess the feasibility of an ED presenting complaint (PC) tool that categorised all ED PCs into 10 categories. Methods: A retrospective analysis of 1445 consecutive patient encounters was conducted. The primary outcome was the frequency of use of the 10 PC categories. Results: Of the 1203 patient encounters meeting inclusion criteria, the PC tool was completed by clinicians in 574 (47.7%). When completed, the tool's 10 options were selected for most presentations (72.3%). Conclusion: The PC tool captured the majority of presenting complaints in 10 categories. External validation is recommended. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to describe the epidemiology and clinical features of patients presenting to the ED with suspected and confirmed COVID‐19. Methods: The COVID‐19 ED (COVED) Project is an ongoing prospective cohort study in Australian EDs. This analysis presents data from eight sites across Victoria and Tasmania for July 2020 (during Australia's 'second wave'). All adult patients who met criteria for 'suspected COVID‐19' and underwent testing for SARS‐CoV‐2 in the ED were eligible for inclusion. Study outcomes included a positive SARS‐CoV‐2 test result and mechanical ventilation. Results: In the period 1 July to 31 July 2020, there were 30 378 presentations to the participating EDs and 2917 (9.6%; 95% confidence interval 9.3–9.9) underwent testing for SARS‐CoV‐2. Of these, 50 (2%) patients returned a positive result. Among positive cases, two (4%) received mechanical ventilation during their hospital admission compared to 45 (2%) of the SARS‐CoV‐2 negative patients (odds ratio 1.7, 95% confidence interval 0.4–7.3; P = 0.47). Two (4%) SARS‐CoV‐2 positive patients died in hospital compared to 46 (2%) of the SARS‐CoV‐2 negative patients (odds ratio 1.7, 95% confidence interval 0.4–7.1; P = 0.49). Strong clinical predictors of a positive SARS‐CoV‐2 result included self‐reported fever, non‐smoking status, bilateral infiltrates on chest X‐ray and absence of a leucocytosis on first ED blood tests (P < 0.05). Conclusion: In this prospective multi‐site study from July 2020, a substantial proportion of ED patients required SARS‐CoV‐2 testing, isolation and enhanced infection prevention and control precautions. Presence of SARS‐CoV‐2 on nasopharyngeal swab was not associated with death or mechanical ventilation. [ABSTRACT FROM AUTHOR]

Objective: The number of patients with suspected COVID‐19 presenting to Australian EDs continues to impose a burden on healthcare services. Isolation is an important aspect of infection prevention and control, but has been associated with undesirable consequences among hospital inpatients. The aim of the present study was to determine if isolation is associated with an increased length of stay (LOS) in the ED. Methods: The Registry for Emergency Care Project is a prospective cohort study with a series of nested sub‐studies. The present study was a retrospective analysis of adult patients allocated an Australasian Triage Scale category of 1 or 2 who presented to a tertiary ED between 18 and 31 May 2020. The primary outcome was ED LOS. Regression methods were used to determine the independent association between ED isolation and LOS. Results: There were 447 patients who met inclusion criteria, of which 123 (28%) were managed in isolation. The median (interquartile range) ED LOS was 259 (210–377) min for the isolation group and 204 (126–297) min for the non‐isolation group, a difference in median ED LOS of 55 min (P < 0.001). Isolation was independently associated with a 23% increase in ED LOS (P = 0.002) and doubled the odds of an ED stay of more than 4 h (adjusted odds ratio 2.2 [1.4–3.4], P = 0.001). Conclusion: Consistent with the anecdotal experience of Australian ED clinicians, the present study demonstrated an increased ED LOS for patients managed in isolation. Enhanced infection prevention and control precautions will be required during and beyond the current pandemic, creating significant ongoing challenges for emergency care systems. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to describe the epidemiological and clinical features of ED patients with suspected and confirmed COVID‐19. Methods: The COVID‐19 Emergency Department (COVED) Project is an ongoing prospective cohort study that includes all adult patients presenting to The Alfred Hospital ED who undergo testing for SARS‐CoV‐2. Current guidelines recommend testing for patients with fevers or chills, acute respiratory symptoms or a high‐risk exposure history, as well as implementation of infection prevention and control precautions for all suspected and confirmed cases. Study outcomes include a positive SARS‐CoV‐2 test result and intensive respiratory support. Results: In the period 1–30 April 2020, 702 of 3453 ED patients (20%; 95% CI 19–22) were tested, with a significant increase during the study period (incident rate ratio 1.019; 95% confidence interval 1.017–1.021, P < 0.001). The primary outcome of a positive SARS‐CoV‐2 test was recorded in 14 patients (2%; 95% confidence interval 1–3). Shortness of breath (77%), fatigue (100%), myalgia (67%) and diarrhoea (67%) were common among positive cases, while close contact (9%), fever (0%) and healthcare occupation (0%) were not. No positive cases required intensive respiratory support in the ED. Conclusions: The volume of ED patients with suspected COVID‐19 is increasing. Low numbers of positive cases precluded development of accurate predictive tools, but the COVED Project is fulfilling an important role in monitoring the burden of infection prevention and control requirements on the ED. The increasing number of patients meeting isolation criteria has the potential to impact on patient flow and may lead to ED overcrowding. [ABSTRACT FROM AUTHOR]

Objective: In Australia, the current ED burden related to COVID‐19 is from 'suspected' rather than 'confirmed' cases. The initial aim of the Registry for Emergency Care (REC) Project is to determine the impact of isolation processes on the emergency care of all patients. Methods: The REC Project builds on the COVID‐19 Emergency Department Quality Improvement (COVED) Project. Outcomes measured include times to critical assessment and management. Results: Clinical tools will be generated to inform emergency care, both during and beyond the COVID‐19 pandemic. Conclusions: The REC Project will support ED clinicians in the emergency care of all patients. [ABSTRACT FROM AUTHOR]

Objective: The COVID‐19 Emergency Department (COVED) Quality Improvement Project aims to provide regular and real‐time clinical information to ED clinicians caring for patients with suspected and confirmed COVID‐19. The present study summarises data from the first 2 weeks of the study. Methods: COVED is an ongoing prospective cohort study that commenced on 1 April 2020. It includes all adult patients presenting to a participating ED who undergo testing for SARS‐CoV‐2. Data are collected prospectively and entered into a bespoke registry. Outcomes include a positive SARS‐CoV‐2 polymerase chain reaction test result and requirement for intensive respiratory support. Results: In the period 1–14 April 2020, 240 (16%) of 1508 patients presenting to The Alfred Emergency and Trauma Centre met inclusion criteria. Of these, 11 (5%) tested positive for SARS‐CoV‐2. The mean age of patients was 60 years and the commonest symptoms were acute shortness of breath (n = 122 [67%]), cough (n = 108 [56%]) or fever (n = 98 [51%]). Overseas travel or known contact with a confirmed case was reported by 24 (14%) and 16 (10%) patients, respectively. Fever or hypoxia was recorded in 23 (10%) and 11 (5%) patients, respectively. Eleven (5%) patients received mechanical ventilation in the ED, of whom none tested positive for SARS‐CoV‐2. Conclusions: Among patients presenting to a tertiary ED with suspected COVID‐19, only a small proportion tested positive for SARS‐CoV‐2. Although the low incidence of positive cases currently precludes the development of predictive tools, the COVED Project demonstrates that the rapid establishment of an agile clinical registry for emergency care is feasible. [ABSTRACT FROM AUTHOR]

Objectives: There is an urgency to support Australian ED clinicians with real‐time tools as the COVID‐19 pandemic evolves. The COVID‐19 Emergency Department (COVED) Quality Improvement Project has commenced and will provide flexible and responsive clinical tools to determine the predictors of key ED‐relevant clinical outcomes. Methods: The COVED Project includes all adult patients presenting to a participating ED and meeting contemporary testing criteria for COVID‐19. The dataset has been embedded in the electronic medical record and the COVED Registry has been developed. Results: Outcomes measured include being COVID‐19 positive and requiring intensive respiratory support. Regression methodology will be used to generate clinical prediction tools. Conclusion: This project will support EDs during this pandemic. [ABSTRACT FROM AUTHOR]