Clinical Pathway for Emergency Department Screening
and Evaluation for 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
  • Triage PPE
  • Hand Hygiene
    • Mask + Eye Protection
No Respiratory Symptoms
Cough, SOB with or without Fever
Mask to patient, all
family members
All Acuities
Main ED Waiting B,C
Team 1
Overflow to Team 2
Behavioral Health:
BH 1 or EC BH 7-10
ESI 1, 2, 3
Waiting A
ESI 4,5
Waiting A or D
Team 3
Overflow to Team 4
Mask + Eye Protection
For All Patients
Modified Expanded Precautions for All Patients
Expanded Precautions for Aerosol-Generating Procedures
SARS-CoV-2 Testing Recommendations
  • Patient Care Considerations
  • Symptoms History
  • Fever (Temp > 100.4°F) or
  • Sore throator
  • 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
    endemic regions
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
  • Exceptions:
    • Patient scheduled for aerosol-generating procedure within next 7 days
    • Reside in congregate living facilities
Yes
  • Examples: shelters, residential facilities
Symptomatic
  • Healthy pts with no high-risk or healthcare/ first responder household members
No
  • Treat patient as presumed positive in home isolation*
  • With the any of the following:
    • Unavoidable contact with high-risk household members
    • Unavoidable contact with critical health care worker/first responder
      household members
    • Patients with high-risk medical conditions and/or will require critical
      health services within 14 days
      after symptom onset
    • Reside in congregate living facilities
Yes
Disposition
Discharge
Admission

COIVD 19 Patient Placement

Posted: January 2020
Revised: February 26, 2020; March 2, 9, 13, 17, 18, 20, 23, 26, 27, 30, 31; April 1, 2, 3, 6, 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