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
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
  • 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
  • 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
  • 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