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

Current Screening for 2019 Novel Coronavirus Disease (COVID-19)
  • 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
Main ED Waiting B,C
Main ED Waiting A
Escort Patients to Next Available Room
  • AGP Existing/Likely
    • Negative Pressure Rooms as available;
    • Single room, door closed if not available
  • BH Patients
    • EDBH Rooms or
    • ECBH Rooms if eligible
Mask + Eye Protection + HH + Gloves for All Patients (Gowns per symptoms)
Modified Expanded Precautions for COVID Symptoms, COVID Exposure, Known COVID
Expanded Precautions for Aerosol-Generating Procedures
Current Testing Recommendations for SARS-CoV-2
Patient Care Considerations
ED Asthma Pathway Changes in the setting of COVID-19
For patients requiring Asthma Treatment, MDI is preferred
Therapeutic Considerations for Patients with Severe COVID-19
Pathway for Evaluation and Treatment of Patients with Active COVID-19 Infections
Expected Acute Hospital Admission or Procedure (Peri-Operative Guidance)
Assess Symptoms Type of Test Recommended
Symptoms Present Rapid Diagnostic SARS-CoV-2 Test
No Symptoms
  • Rapid Pre-admission/procedure Screening
  • SARS-CoV-2 Test
Expected Discharge
Assess Symptoms Type of Test Recommended
Symptoms Present
  • Standard COVID Test
  • Results available 24-36 hrs after discharge
  • Results
    • Available MyCHOP
    • ED APP calls for positive results
No Symptoms No Testing
No Symptoms and Exposed
Clearance of Transmission-Based Precautions
Asymptomatic/SARS-CoV-2 positive At least 10 days have passed since the date of the first positive test
Symptomatic/SARS-CoV-2
positive or suspected
  • At least 10 days has passed since symptoms first appeared and
  • At least 24 hours have passed since last fever w/o use of fever medications and
  • Symptoms are improved
No Symptoms and Exposed
  • Exposed patients quarantine for 10 days after last exposure as long as they remain asymptomatic
  • This can be reduced to 7 days if they test negative day 7 and remain asymptomatic. PCR testing is required if tested day 5 or 6, Rapid Ag Test may be used day 7 or after
  • Patients should continue to monitor symptoms for 14 days
No symptoms, Vaccinated and Exposure
  • Vaccinated persons with exposure to suspected/confirmed COVID-19 do not need to quarantine if they:
    • Are 2 weeks past their full vaccination series
    • Have remained asymptomatic since their COVID-19 exposure
  • This is true for household exposures
  • Schedule a future covid test
Disposition
Discharge
Admission
Posted: January 2020
Revised: February 2020, March 2020, April 2020, May 2020, June 2020, July 2020, September 2020, October 2020,
November 2020, December 2020, January 2021, February 2021, March 2021, May 2021, June 2021, July 2021
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