title: Effectiveness of the Middle East respiratory syndrome-coronavirus protocol in enhancing the function of an Emergency Department in Qatar.
abstract: OBJECTIVE
  This study aimed to investigate the effectiveness of a Middle East respiratory syndrome coronavirus (MERS-CoV) surveillance protocol in the Emergency Department (ED) at Hamad General Hospital. Effectiveness was measured by: (a) reduction in the number of patients admitted into the MERS-CoV tracking system; (b) identification of positive MERS-CoV cases; (c) containment of cross infectivity; and (d) increased efficiency in ED functioning.
  
  
  METHODS
  A retrospective chart review was carried out of all ED patients suspected of MERS-CoV during the height of the epidemic (August to October 2013). An algorithm was created on the basis of international guidelines to screen and triage suspected MERS-CoV patients. Once identified, patients were isolated, had a chest roentgenogram [chest radiography (CXR)] taken, and a nasopharyngeal swab for polymerase chain reaction (PCR) was sent with sputum samples for testing. Patients with normal CXR and mild respiratory symptoms were discharged with home isolation instructions until nasopharyngeal and sputum PCR results were available. Patients with fever and acute respiratory distress, with or without abnormal CXR, were treated in the hospital until tests proved negative for MERS-CoV.
  
  
  RESULTS
  The protocol successfully reduced the number of patients who needed to be tested for MERS-CoV from 12,563 to 514, identified seven positive cases, and did not lead to apparent cross infectivity that resulted in serious illness or death. The protocol also increased the efficiency of ED and cut the turnaround time for nasopharyngeal swab and sputum results from 3 days to 1 day.
  
  
  CONCLUSIONS
  A highly protocolized surveillance system limited the impact of MERS-CoV on ED functioning by identifying and prioritizing high-risk patients. The emergence of new infectious diseases requires constant monitoring of interventions to reduce the impact of epidemics on population health and health services.
authors.affiliation: aEmergency Medicine bHealth Services Research cInfectious Diseases, Hamad Medical Corporation, Doha, Qatar dDepartment of Sociology and Global Health, Duke University, Durham, North Carolina, USA eDepartment of Emergency Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Shinu
authors.initials: S
authors.lastname: Varughese
authors.forename: Jennan G
authors.initials: JG
authors.lastname: Read
authors.forename: Abdullatif
authors.initials: A
authors.lastname: Al-Khal
authors.forename: Salem
authors.initials: S
authors.lastname: Abo Salah
authors.forename: Yasser
authors.initials: Y
authors.lastname: El Deeb
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cameron
mesh_terms: D015331:Cohort Studies; D003140:Communicable Disease Control / Q000458:organization & administration*; D018352:Coronavirus Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D004638:Emergency Treatment; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D065207:Middle East Respiratory Syndrome Coronavirus / Q000302:isolation & purification; D058873:Pandemics / Q000517:prevention & control; D010356:Patient Isolation; D015995:Prevalence; D011780:Qatar / Q000453:epidemiology; D011787:Quality of Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D062606:Tertiary Care Centers; D016896:Treatment Outcome