The COVID-19 pandemic has placed significant stress on resources within Emergency Departments across the country. Providing adequate standards of care, minimizing staff exposure, and improving patient outcomes are some of the many challenges that are currently being faced. Second year resident Dr. Jack Yancey and Dr. Terren Trott, board certified in both Emergency Medicine and Pulmonary/Critical Care, recently worked together to develop a self-proning protocol to improve outcomes for hypoxic patients in the ED. Proning, or carefully turning a patient from laying on their back to laying on their abdomen, is an evidence-based intervention that allows for better expansion of the lungs in patients with compromised oxygen saturation. Proning is recommended for intubated patients experiencing severe acute respiratory distress syndrome, but anecdotal evidence has shown that non-intubated patients may also benefit from the positional change.
"The idea for an ED driven self-proning protocol originated in New York during the initial surge of COVID patients," says Dr. Yancey. "Dr. Trott and I wanted to replicate this within our department in preparation for a similar surge. We collaborated with our medical ICU and inpatient medicine teams to create a standardized protocol that could be used in the ED. I met with many of our charge nurses to get their feedback and after several revisions we were able to officially get the protocol put in place. To date, the protocol has been successful; many patients get boarded in the ED as many beds upstairs are full. In simple terms this improves oxygenation by minimizing mismatch between good and bad lung areas. Like every hospital, we have limited numbers of ventilators and high flow nasal canula devices; therefore this is one way by which we can optimize patients' lung mechanics to alleviate stress on our limited resources." Excellent work, Drs. Trott and Yancey!