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
    • BH-1, ECBH 7-10, as available
Mask + Eye Protection + HH + Gloves for All Patients (Gowns per symptoms)
Modified Expanded Precautions for Respiratory Symptoms, Exposure , Known COVID
Expanded Precautions for Aerosol-Generating Procedures
SARS-CoV-2 Testing Recommendations
Patient Care Considerations
ED Asthma Pathway Changes in the setting of COVID-19
For patients requiring Asthma Treatment, MDI is preferred
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
  • Full Exposure Definition with Examples
    • Prolonged (> 15 minutes), close (< 6 feet) contact with a person who is COVID-positive
  • Spent 15 cumulative minutes within 6 ft of a symptomatic or pre-symptomatic person who is COVID-positive
  • Exceptions:
    • Required by Department of Public Health/School/Employer/Other Authority for post-exposure contact tracing
    • Patient scheduled for aerosol-generating procedure within next
      24-72 hrs
  • Pre-Operative Screening
Yes
  • Test children if required for admission to another facility such as shelters or residential facilities
Symptomatic All patients Yes
  • Treat patient as presumed positive in home isolation, until SARS-CoV2 results available
  • **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 even if COVID test is negative

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

COVID-Recovered Patients and Re-Testing with New Symptoms
Disposition
Discharge
Admission
  • 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 2020, March 2020, April 2020, May 2020, June 2020, July 2020, September 2020, October 2020,
November 25, 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