COVID-19: Is Your ED Prepared for the Next Wave of Patients?

Added on May 27, 2020

Wood, BrianBy Brian Wood, Senior Associate, Strategic Consulting

When a virus as contagious as COVID-19 strikes, it rarely strikes once. Hospital staff must anticipate surges in patient volumes as the virus spreads, responding expeditiously while developing standard protocols and best practices to rely on in uncertain circumstances. What this means for emergency departments across the country is that even as they are beginning to feel relief from the flattened curves of very ill COVID-19 patients, they need to plan for recurrent spikes.

Following are some of the strategies they should use to prepare for a future wave of patients.

  1. Reflect on the first wave.
    • Conduct a general review of operations and the effectiveness of the organization’s disaster plan in the past 30 days.
    • Assess the quantity of PPE that has been utilized in the ED and designate a supply person to track its use. This information is essential to plan for the recurrent spikes.
    • Evaluate the consistency of communication among staff.
    • Assess areas of the hospital where surge concerns will not have an impact to determine who can assist in the ED without impacting other hospital operations.


  2. Plan for the second wave.
  • If not already in place, establish a group of leaders to evaluate ongoing operations and course-correct as needed. This group should include a senior leader, ED medical and administrative leaders, and representatives from front-line staff from all shifts. Since EDs are affected by other department operations (throughput, supplies, medications, etc.), the group should consider these issues when planning for the next surge.
  • Consider moving triage operations to a tented area outdoors to minimize contamination of facilities and staff. If the ED can’t support an outdoor triage station, position nurses at the entrance to evaluate symptoms and direct patients to designated waiting areas. If immediate rooming is not available, create a designated waiting area for patients experiencing elevated temperatures and/or respiratory complaints so that they are separated from patients with trauma, abdominal pain, and other non-COVID-related symptoms.
  • Evaluate staffing capacity. Identify additional staff from other service areas who can be redeployed to locations within their knowledge and skillsets.
  • Develop a condensed version of the hospital and department orientation program to present to travel and agency nurses.
  • When using augmented staffing, ensure that each team has an experienced ED nurse to coordinate team member assignments.
  • Mandate huddles to occur every six hours to ensure consistent communication. Depending on the ED’s management structure, assign the nurse manager, assistant, or charge nurses as lead individuals to convey essential information from the command center to staff at the huddles.

Following each wave of patients, ED leadership, staff, and C-suite members should conduct a post-incident steering committee meeting to evaluate safety and quality considerations, resource utilization and replenishment, and overall preparedness for future waves or other large-scale crises.

To learn more about this topic, please reach out to the Press Ganey Strategic Consulting team at

Visit our dedicated COVID-19 webpage for additional resources.