July 24, 2020

U-M Emergency Medicine leads international COVID preparedness survey

The first truly global study of COVID-19’s comparative impact on hospital emergency rooms around the world is being driven by Michigan Medicine.

The survey of 74 emergency rooms across 41 countries was conducted by the network EMERGE (Emergency Medicine Education and Research by Global Experts), formed recently by Professor and Vice Chair of Emergency Medicine Prashant Mahajan, MD, MPH, MBA.

COVID-19 started to take hold this January, the same month that members of the fledgling network formalized a governance structure and elected leaders, creating both a proving ground and stress test for the new research network, Mahajan said.

“We were really just getting started, but if your global network of emergency departments doesn’t react to COVID, what is the point of the network?” he said. “We are all struggling with the same issues, so the core idea is to have everyone share what they are doing so we can be able to help each other.”

He and his team designed a survey and made it available in English, Spanish and Mandarin. They gathered responses from hospitals in Chile, Brazil, Ghana, Pakistan, Israel, Australia, China, Germany and Japan, among many others. Sites included both EMERGE network and non-member institutions, with a response rate of nearly 60%.

“We began this project unsure whether, in the midst of this crisis, people would take the time to participate,” said EMERGE network Manager Apoorva Belle. “Despite being busy, people came forward to share their data. I think there’s a sense of community and purpose, sharing information for the greater good.”

The survey stuck largely to broad pandemic response topics: treatment protocols, screening and triage practices, personal protective equipment (PPE), staffing, and more. With participating hospitals across six continents, Mahajan believes the results shed light on the global emergency medicine response. Analysis is underway, but some topline takeaways include:

  • 70% of the responding departments reported having healthcare workers test positive for COVID-19;
  • Powered Air Purifying Respirators and N95 masks topped the list of scarce PPE, with more than 50% of respondents indicating a shortage of these two items;
  • More than 90% of responding hospitals indicated postponing non-urgent procedures to increase capacity, but less than 40% reported expanding capacity by adding additional beds.

Respondents included hospitals both public and private, academic and non-academic, small and large. Because of the scope – topical and geographical – responses need to be carefully analyzed across different factors before drawing any conclusions. Even the fluid timing of the pandemic, which strikes different places at different times as the virus spreads among the population, presents a unique challenge; a hospital that reported no PPE shortage in May when the survey was conducted might by June have been scrambling to source gowns and gloves.

“One of our biggest challenges is contextualizing the data in terms of the global COVID timeline,” Mahajan said. “The different stages at which a country happened to take the survey makes a huge difference and is a complicating factor as we examine the results.”

Nonetheless, there are meaningful insights to glean, he said.

“It seems pretty clear that, while most systems prepare for some kind of disaster, many were unprepared for a pandemic. Also, when it comes to staffing, there is a true cost human cost of people getting ill and people burning out. That is universal,” Mahajan said. “Beyond that, there are definitely lessons learned. How did system create effective triage area in a tent? How did they expand ICU space? Those anecdotal stories are extremely valuable.”

A manuscript is in progress. Beyond reporting and contextualizing the initial survey results, next steps planned include follow-up surveys focused on individual topics such as staff wellness and burnout. Mahajan also hopes to coordinate with the EMERGE network sites that are able to share patient data internationally for a multi-center study looking at which patients are most likely to improve and recover.

A secondary goal: to continue to grow the number of EMERGE member sites. Three non-member sites who completed the survey have subsequently joined the network, bringing the total number to 26 and counting.

“This survey is an incredible opportunity show the value of our the network,” Mahajan said. “COVID has clearly demonstrated that the world is borderless. You need international collaboration and knowledge sharing to understand and improve.”