Control of Sources of Infection
On March 3, 2020, NHC issued the New Coronavirus Pneumonia Diagnosis and Treatment Program (Trial 7th Edition) (National Health Office Medical Letter 184), pointing out that patients with COVID-19 are the main source of infection . According to the document New Coronavirus Pneumonia Prevention and Control Program (6th Edition) (CDC Letter 204)  issued by NHC on March 7, 2020 ， PKUFH took the following measures to achieve "early detection, early reporting, early isolation, early treatment" and to control the spread of the epidemic to the greatest extent.
Establishment of a three-level pre-examination and diagnosis system to promptly detect suspected cases
Set-up of three 24-hour temperature monitoring stations
24-hour temperature monitoring stations were set up at the entrances of the ED, the entrance of the emergency hall, and the emergency triage station. Non-contact infrared temperature monitoring equipment was used at the first two stations, and electronic thermometers with higher accuracy were used at the last station. The responsibilities of the medical staff at these stations were to check patients for body temperatures and proper wearing of masks, and to educate patients on cough etiquette. Patients with fevers (forehead temperature over 37.3 ° C) were provided with free surgical masks and educated to wear masks properly, and then guided by a designated person to the Fever Clinic following established routes. After ruling out the possibility of COVID-19 infection and recording the patient encounter at the Fever Clinic, patients then returned to the ED. Monitoring for abnormal body temperatures was reported daily to the administrative department for dynamic monitoring.
Conducting epidemiological surveys on all patients and their families
Questionnaire-based survey: the epidemiological questionnaire, based on New Coronavirus Pneumonia Diagnosis and Treatment Program, was designed and updated dynamically. All patients entering the ED were requested to fill out online or paper-based questionnaires at the entrance of the emergency hall. When abnormalities were detected in the online questionnaires, SMS alerts would be sent automatically to the staff. Paper-based questionnaires were to be completed by dyslexia patients with the assistance of on-site staff. Nurses at the emergency triage station were responsible for reviewing questionnaires and providing supplemental information to attending physicians if any abnormities were noticed. After patients entered the clinic, the attending physician would again inquire history of contact and record epidemiological history in the patient’s medical record routinely. Nurses at the emergency triage station would summarize abnormal situations and report to the administrative department for dynamic monitoring.
Itinerary verification: personal itinerary inquiry services could be obtained through the epidemic prevention and control communications big data itinerary card, launched by the Information and Communications Administration Bureau of the Ministry of Industry and Information Technology. This service allowed identification of where patients and their families had travelled within the country or abroad in the past 14 days, including foreign countries (regions) and domestic cities (staying over 4 hours). It was used to determine whether the patient had risks of exposure to an epidemic area.
Timely reporting of suspected cases
Upon identification of a new suspected case in the ED, fever experts would convene for a group consultation. If the suspected patient was confirmed, the form of “Basic Information Form of COVID-19 suspected patient” was to be filled out, including but not limited to the patient's name, sex, date of birth, ID number, contact phone number, incidence, isolation location, and epidemiological history. Meanwhile, this suspected case would also be reported to the Prevention and Control of Healthcare-associated Infections Department of PKUFH which is responsible for reporting it to higher-level disease control bodies.
Isolation of suspected patients and local treatment
The suspected patient identified by the ED would be isolated on the spot and given proper medical treatments. The second-line consultation in the Fever Clinic consultation would be conducted if necessary. Once the patient was diagnosed with COVID-19, the ED would report to the Medical Affairs Department which coordinates the transfer of the patient to a designated hospital. People in close contact with the patient would receive medical isolation, and the isolation area would undergo terminal disinfection.
Cutting off transmission routes
Given that the main transmission routes of the 2019-nCoV are through respiratory droplets and direct contact, virus transmission was minimized to the greatest extent by setting up physical partitions, emergency zoning, reduction in emergency personnel density, and strict cleaning and disinfection.
Set-up of physical partitions, management of travel routes of patients and medical staff
The temperature of the patient must be measured before entering the ED. Patients with fevers would be guided directly to the Fever Clinic located outside of the ED to avoid contact with the medical staff and patients in the ED.
Fences were erected outside of the ED to block access from the ED to the outpatient building, inpatient departments, administrative office areas, to restrict the cross-flow of emergency medical staff and patients to other areas. The two original entrances and exits in the ED were reduced to just one during the epidemic.
Behavioral isolation is equally or even more important than the physical partitioning . The staff in the ED, outpatient building and inpatient departments in PKUFH had fixed and separate positions during the epidemic without overlap.
Reasonable zoning in the ED, use of reserve emergency space, and reduction in personnel density
According to the requirements of prevention and control of healthcare-associated infections(HAIs), the layout of the ED was rearranged and divided into contaminated area, potentially contaminated area, and clean area. Each area was equipped with single rooms for isolation. Infusion chairs and hospital beds were separated, thereby reducing the personnel density. In addition, the emergency conference room was renovated (with treatment belts, etc.) as an expanded area in anticipation of a surge in patients under observation.
Meanwhile, the number of patients admitted in the established space was reduced. To meet the medical needs of patients, PKUFH immediately added more hospital beds in the emergency hall, a place originally designed for public health emergencies. Screens were set up around each bed as a physical partition to hinder the spread of droplets and for protecting privacy of the patients.
Strengthening maintenance of order and guiding patients to providers in an orderly manner
Security officers were positioned at the entrance of the ED for order maintenance. According to the principle of "one escort for each patient ", the escort ID was issued to the escort personnel. Patients with self-care ability were not issued with escort cards. More medical guides and medical care providers were assigned to the ED to assist patients with mobility difficulties to obtain medicines and receive examinations.
Reduction in gathering and management of social distancing
The ED was equipped with self-service machines with functions of registration and payment. As a result, the number of people registering and paying at the manual windows, as well as the waiting time, were reduced.
To remind the patients and escorts to maintain a distance of at least one meter or two seats apart while waiting, signs were posted in waiting areas, such as at the triage stations, cashier desks, pharmacies, and blood collection windows. The signs read “seat should be kept unoccupied” or “empty seat” were posted to the back of the seats accordingly.
Strict compliance of emergency treatment standards and admission procedures, reasonable diversion of patients
Patients without urgent indications were guided to the Outpatient Departments, and in principle, outpatient patients were not allowed to go to the ED for auxiliary examination.
The ED and the Inpatient Departments worked together to define the COVID-19 rapid detection and admission processes for key critical patients (acute coronary syndrome, acute pancreatitis, gastrointestinal bleeding, etc.). Patients who tested negative for COVID-19 and fell under the admission indications list were to be admitted to the Inpatient Departments timely. The admission process for emergency patients is indicated in Figure 1.
Professionals of Prevention and Control of Healthcare-associated Infections Department Department visited the ED daily to conduct on-site supervision and improvement, including environment and equipment disinfection, ventilation (such as timely removal of the curtain after a rise in temperature), hand hygiene of medical personnel, and sewage and sewage treatment.
Under the guidance of Prevention and Control of Healthcare-associated Infections Department Department, the General Affairs Department carried out environmental cleaning and disinfection, disposal of dirt and sewage, and ensured ample supply of disinfectants. In addition, they provided food delivery services for medical staff in the ED to ensure nutrition intake and avoid gatherings of people in the cafeteria.
Meetings for information exchange were held online through WeChat Enterprise during the epidemic. Free online consultation services were set up, allowing patients discharged from the ED to receive medical consultation remotely when they had any questions.
Protecting high-risk groups
2019- nCoV is a new pathogen to which the population is generally susceptible . The elderly and those with underlying diseases are at high risk. Furthermore, medical staff, who are in close contact with patients and perform high risk operations such as sputum aspiration and tracheal intubation, are also COVID-19 high-risk populations.
Implementation of in-hospital training to increase the attention of medical professionals
The emergency medical staff, temperature monitoring staff, and other personnel (such as medical guidance, nursing workers, security guards, cleaning personnel, etc.) were trained in batches both online and offline. In the training sessions, the relevant knowledge of COVID-19 was introduced to help everyone achieve a reasonable concept of protection. Psychological intervention for medical personnel was also a key point in the training session.
Paying attentions to the health status of medical staff
Medical professionals returning to Beijing from other provinces must be self-isolated at home. In principle, medical professionals over 60 years old or with fevers and cough would not be allowed to perform medical tasks. The other of medical professionals were assigned to reasonable shift scheduling that guaranteed sufficient rest.
Mutual assistance between departments
The hospital allocated medical professionals from other departments to help medical professionals in the ED to relieve their workload. Medical personnel assigned to the ED would no longer be allowed to return to the wards or outpatient departments during the epidemic period.
In case of a major rescue effort in the Fever Clinic, the ED should be the backup rescue force at any time.
Ensuring supply of prevention and control materials for medical professionals
The ED was equipped with ample medical protective masks, work caps, disposable protection gowns, goggles, latex gloves and other protective equipment.
The numbers and classifications of emergency patients in the ED were collected from January 22 to March 31, 2020, and from the same period in 2019. According to the Guiding Principles for the Piloting of the Classification of Emergency Patients (Draft for comments) issued by the Medical Management Department of the Ministry of Health in 2011 (Medical Note  No. 148), the disease classification was divided into 1-4 grades, defined as grade 1 (endangered patients), grade 2 (critically ill patients), grade 3 (emergency patients) and grade 4 (non-emergency patients).
The percentage was used to describe the disease grades of patients admitted in the ED from January 22 to March 31, 2020, and from the same period in 2019. Wilcoxon Rank Sum test was used to compare the changes in different disease grades between the two time periods. Statistical analyses were performed in SPSS 20.0, with P <0.05 considered statistically significant.