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 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
  • 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
Test all patients as soon as possible at initiation of patient evaluation
Symptoms Patient Factors Testing Comments
  • Regardless of high-risk medical conditions or presence of high-risk household contacts
  • 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
  • Test children from shelters, residential facilities as clinically indicated.
  • Healthy pts with no high-risk or healthcare/ first responder household members
  • 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
  • **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
  • 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
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