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
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
    • 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 Specimen
Symptoms Present Rapid Diagnostic SARS-CoV-2 Test AN
No Symptoms
  • Rapid Pre-admission/procedure Screening
  • SARS-CoV-2 Test
AN
Expected Discharge
Assess Symptoms Type of Test Recommended Specimen
Symptoms Present
  • Standard COVID Test
  • Results available 24-36 hrs after discharge
  • Results
    • Available MyCHOP
    • ED APP calls for positive results
AN
No Symptoms No Testing AN
No Symptoms and Exposed AN
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 5-7 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
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
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