Room to Maneuver: Implementation of a Pediatric Emergency External Surge Tent during the COVID-19 Pandemic

Objective: We aim to describe the process development and utility of a tent outside a pediatric emergency department (ED) to evaluate low-acuity pediatric patients during a pandemic state. Methods: We utilized a pandemic surge tent outside of a pediatric ED during the COVID-19 pandemic in March 2020-April 2020 to evaluate and discharge low acuity pediatric patients. A nurse-driven protocol was developed to triage appropriate patients to the surge tent; those with symptoms that could be consistent with the pandemic virus, ESI triage level 4 or 5 and those who could be safely evaluated in the tent. Patient volumes in the pandemic surge tent were tracked in comparison to daily ED census. Results: The pandemic surge tent was open for a two-week period at the end of March and beginning of April 2020. Total ED volumes, based on average daily census, were decreased to 40% of normal when compared to similar two-week periods averaged over the prior three years (2017-2019). The pandemic surge tent was used to see 5.4% of the total ED volume for the days that it was in use. Infection control measures for patient and staff safety were maximized via patient cohorting in the tent. Due to low overall patient volumes, no additional ED staff was needed to operationalize the pandemic surge tent. Conclusion: We were effectively able to use an external surge tent to evaluate and discharge appropriate patients during a pandemic state. The surge tent was effective in limiting infection risks inside the main ED, protecting vulnerable pediatric patients, and preserving essential ED staff. Overall low patient volumes did not necessitate further use of the pandemic surge tent. The initial trial period prepared the department for future use should there be a surge of infectious patients.