Emergency Department Clinical Pathway for Screening/Evaluation of Children with Suspected 2019 Novel Coronavirus (COVID-19) Disease

Goals and Metrics
Patient Education
Provider Resources
Related Pathway
Current Screening for 2019 Novel Coronavirus Disease (COVID-19)
ED Process for Arrival of COVID-19 Positive Patient
  • Patient Arrival at Security Desk at Emergency Entrance to ED Waiting
    • Encounter created and exposure screen completed
    • PAC Assessment, Sort ESI Level, Place Pt ID Band
    • ED Visitation Guidance, Mask All Patients, Family Members
  • Triage PPE
  • Hand Hygiene
    • Mask + Eye Protection
No Respiratory Symptoms
Cough, SOB with or without Fever
All Acuities
Main ED Waiting B,C
ESI 1, 2, 3
Waiting A
ESI 4,5
Waiting A or D
Escort Patients to Next Available Room
  • AGP Existing/Likely
    • Negative Pressure Rooms as available;
    • Single room, door closed if not available
  • BH Patients
    • BH-1, ECBH 7-10, as available
Mask + Eye Protection for All Patients (Gowns per symptoms)
Modified Expanded Precautions for Respiratory Symptoms, Exposure , Known COVID
Expanded Precautions for Aerosol-Generating Procedures
ED Room Precaution Recommendations
Precaution Video  
SARS-CoV-2 Testing Recommendations
Use ED EPIC Order Set: Symptomatic vs Screening COVID Test
  • Patient Care Considerations
  • Symptoms History
  • Fever (Temp > 100.4°F) or
  • Sore throat or
  • Cough, respiratory distress, tachypnea, or hypoxia
  • Exposure History
  • No close contact with person with COVID-19 pending or positive test within the last
    14 days
  • Neither patient nor family on self-isolation for presumed disease or from current
    High-Risk regions within the last 14 days
ED Asthma Pathway Changes in the setting of COVID-19
For patients requiring Asthma Treatment, MDI is preferred
Management of Previously Positive Patients
PATIENTS LIKELY TO REQUIRE HOSPITAL ADMISSION
Test all patients as soon as possible at initiation of patient evaluation
TESTING CONSIDERATIONS FOR PATIENTS STABLE FOR CARE AT HOME
Symptoms Patient Factors Testing Comments
Asymptomatic
  • Regardless of high-risk medical conditions or presence of high-risk household contacts
 No
  • If there was an exposure, follow self-isolation procedure for 14 days after exposure with symptom monitoring
    High-Risk Regions
  • Exceptions:
    • Patient scheduled for aerosol-generating procedure within next 24-72 hrs
  • Peri-Operative Guidance
 Yes
  • Test children from shelters, residential facilities as clinically indicated.
Symptomatic
  • Healthy pts with no high-risk or healthcare/ first responder household members
 No
  • Treat patient as presumed positive in home isolation
  • With any of the following:
    • Child returning to camp, daycare or school prior to being cleared from a symptoms-based strategy
    • Unavoidable contact with high-risk household members
    • Unavoidable contact w/essential worker household member who has current in-person work requirements
    • Patients with high-risk medical conditions and/or will require critical
      health services within 14 days
      after symptom onset
    • Patients with high risk medical conditions and will require critical health services within 14 days after symptom onset
    • Reside in congregate living facilities
 Yes
  • **Clearance of home isolation applies to confirmed/suspected and symptomatic/asymptomatic patients and caregivers, but NOT exposed patients and caregivers
  • Clearance of Transmission-Based Precautions for Patients and Caregivers with Confirmed SARS-CoV-2  
    • Asymptomatic/SARS-CoV-2 positive:
      • At least 10 days has passed since the date of pts first positive viral test
    • Symptomatic/SARS-CoV-2 positive or suspected
      • At least 10 days have passed since symptoms first appeared; and
      • At least 24 hrs have passed since last fever w/o use of fever medications and symptoms have improved
    • Exposed patients: Home isolation for 14 days after exposure with symptoms monitoring

CDC: Discontinuation of Home Isolation for Persons with COVID-19 (Interim Guidance)  

COVID-Recovered Patients and Re-Testing with New Symptoms
Disposition
Discharge
Admission
  • Use COVID-19 Discharge Smart Set if patient tested
  • Follow self-isolation procedure for 14 days
  • Process for revisit
  • APP Follow-up
  • COVID Discharge Instructions
  • Peri-Operative Guidance
  • Patients should have pre-procedure screening the
    day prior
  • If unable, testing 72 hrs prior is acceptable if:
    • All household members/patient self-monitor for symptoms and
    • Have no social contact outside of their household
    • Report symptoms immediately
  • CHOP Provider can enter EPIC order:
    • “Consult to drive Through”
    • Testing can be scheduled at Roberts or
      Bucks SCC

COIVD 19 Patient Placement

Posted: January 2020
Revised:
February 26, 2020;
March 2, 9, 13, 17, 18, 20, 23, 26, 27, 30, 31, 2020;
April 1, 2, 3, 6, 8, 11, 15, 17, 18, 22, 23, 24, 2020;
May 1, 4, 5, 15, 2020;
June 8, 17, 24, 2020;
July 7, 16, 21, 27, 2020;
Authors: K. Cohn, MD; L. Handy, MD; J. Sammons, MD; V. Kampalath MD; J. Lavelle MD; K. Chiotos, MD;
S. Myers, MD; M. K. Abbadessa, MSN, RN; S. Coffin, MD