Dubbo Hospital's Emergency Department (ED) can handle a "huge hit" of coronavirus cases because of the community's response to the pandemic, says Dr Daniel Stewart.
The hospital's director of emergency medicine said Dubbo residents' observance of social distancing and hand washing had kept many of them well and given the ED time to "plan and prepare" for the worst-case scenario.
On Thursday the specialist emergency physician noted the national rate of confirmed cases of the coronavirus, called COVID-19, was "starting to slow" but declared it "early days" in the fight against the potentially-deadly virus.
Dr Stewart offered reassurance the ED, hospital and Western NSW Local Health District were up to the challenge having had some lead-in time thanks to the public.
"I feel like we are prepared and can take a huge hit if it ever came," he said.
Preparations for the pandemic have included the establishment in mid-March of the Stand-Alone Fever Flu Evaluation (SAFFE) clinic.
The director said the clinic was located at the "front of the hospital in the old pre-admissions area" but was still under his clinical leadership and considered part of the ED.
"The purpose of the SAFFE clinic is to reduce the total patient load on the Emergency Department during a respiratory illness, flu season," Dr Stewart said.
He said more than 500 people had passed through its doors with four being diagnosed with the coronavirus. A fifth case had been diagnosed in the ED.
Dr Stewart said the triage of all patients took place at the ED.
"Patients who present with flu-like illness will go to the SAFFE clinic if it is clinically appropriate and safe to do so," he said.
"In the same clinic they will undergo a clinical screen and if they meet suspect case criteria they will undergo coronavirus testing, otherwise they will be assessed in the clinic and will almost always be discharged home.
"The majority of patients do not meet coronavirus screening criteria."
Last week the director and his staff moved into the "biggest emergency department in country NSW" in the yet-to-be completed and three-storey Macquarie Building.
As of Monday it has hot and cold zones, the latter for people with conditions other than coronavirus. "The hot zone is an area which can safely receive patients who are suspect cases or confirmed cases," Dr Stewart said.
"They'll receive a clinical assessment, various investigations will be performed and they will receive treatment. Then they will either be able to be discharged home immediately to home isolation, much as they can be from the SAFFE clinic.
".. if they can't be discharged home they will be admitted to the hospital to a designated respiratory ward which is part of the emergency response plan that the hospital has activated."
Dr Stewart said critically unwell patients would need to be admitted to the hospital's Intensive Care Unit but they would be in the "minority". The director said the vast majority of patients would be able to go home while others "might need a night or two in the hospital".
The move to the new ED has come at the right time. "Unlike the old department we are very lucky to have four large isolation rooms with a door that we can close," Dr Stewart said. "The old department had no capacity really. It had two isolation rooms that were very small and not fit- for-purpose."
Dr Stewart said four beds were enough "under current clinical load". He said the hospital's response to the pandemic included "rapid assessment by senior clinicians" resulting in discharge or admission. "It's always safe as well and that way if we need to we can move many patients through that space over a 24-hour period," Dr Stewart said.
The director said contingencies had been put in place to maintain or boost staffing levels. He said the ED was currently not short of doctors and nurses but winter always took a toll.
"We have had some staff go into isolation because of contact with a recent case of coronavirus," the director said. "Some of those staff are returning back to work. The Emergency Department is well-staffed for the foreseeable future with our existing staffing model."
Dr Stewart said if staff had to go on sick leave or self-isolate, staff from other parts of the hospital would be deployed to the ED when available. He said from 8am to midnight the ED operated under the supervision of a specialist emergency physician.
The director has thanked the community for its support ranging from deliveries of food to posts on the Dubbo thumbs up Dubbo thumbs down Facebook page. On Friday, confirmed cases of COVID-19 in Dubbo remained at six.