Impact of negative-pressure room utilization in the emergency department on hospitalized pneumonia patients during the COVID-19 pandemic in Thailand.

Background: During the coronavirus disease 2019 (COVID-19) outbreak, negative-pressure rooms were implemented to isolate high-risk COVID-19 patients. This study compared pneumonia patient outcomes before and after their implementation, focusing on in-hospital mortality as the primary outcome. Methods: We conducted a retrospective cohort study of adult pneumonia patients admitted to a tertiary hospital in Northern Thailand, excluding those with trauma-related illness, out-of-hospital cardiac arrest/in-hospital cardiac arrest, or incomplete data. The primary outcome was in-hospital mortality, and the outcomes were door-to-first doctor contact time, door-to-antibiotic time, emergency department (ED) length of stay (LOS), intensive care unit (ICU) admission, and 30-day mortality. Results: Data from 220 pneumonia patients (104 pre-pandemic, 116 pandemic) were analyzed. Of these, 58.6% were elderly males with comorbidities like hypertension and diabetes. Door-to-first doctor contact time was longer during the pandemic (median, 1 vs. 0 minutes; P<0.001), as was ED LOS (median, 5.9 vs. 4.1 hours; P<0.001). Door-to-antibiotic time was also longer in unadjusted comparisons (median, 60.0 vs 36.5 minutes; P<0.001), but the difference was attenuated and not statistically significant after adjustment (adjusted mean difference, 14.2 minutes; P=0.071). No significant differences in in-hospital mortality, 30-day mortality, or ICU admissions were observed. Conclusions: Negative-pressure rooms led to increased door-to-doctor contact time and ED LOS during COVID-19, although without significant differences in mortality. These findings highlight the need to improve ED workflows for future pandemic preparedness.