Why should we apply the practice of “cohorting” practitioners/machines/patients?

1. Why should we apply the practice of “cohorting” practitioners/machines/patients?

According to the World Health Organization (WHO), “cohorting” refers to the practice of caring for more than one patient in the same designated place by the same designated staff.1

From our experience in dealing with novel coronavirus disease (COVID-19), the ideal setting involves creating three distinct groups:

  • patients presumed negative;
  • patients presumed positive;
  • positive patients.

In the event that identifying three distinct hospitals or individual pathways is not feasible, patients who are presumed positive can be merged with the positive patients, albeit paying particular attention to sanitization and disinfection procedures,which are mandatory between patients.

Dividing patients into separate groups potentially decreases the risk of healthy patients being infected in unrestricted and widely accessible spaces (such as waiting rooms),2 or through close contact with the staff. 2 This approach also reduces contagion of health workers, provided that they utilize personal protection equipment (PPE) correctly, in correlation with infectious risk.3,4

From the Italian COVID-19 experience,5 separating staff into different groups according to patients they interact with allows more rationalized health surveillance of practitioners, and minimizes the risk that staff become means of transmission for more vulnerable patients such as the elderly, or the immunocompromised. The contagion of a healthy patient during a diagnostic procedure, especially while hospitalised, entails a significant risk of contagion for all staff who will subsequently be in contact with them.

In Singapore, tents and extension were set up outside the emergency department. A dedicated cubicle inside the tent will house a mobile digital x-ray machine, mobile cassette holder to allow PA projection and a black drape to visualise collimator beam during the day. The layout is as shown.6

Pictures provided by the National University Hospital, Singapore

The use of portable x-ray outside the emergency department minimises patient movement and allows the segregation of suspected COVID-19 patients from other patients who came to the emergency department for non COVID-19 attention, thus minimising cross contamination.