COVID-19 Screening Clinical Pathway — Inpatient | Children's Hospital of Philadelphia

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Inpatient SARS-CoV-2 Testing Recommendations

Testing Indications
- All Patients on Admission Universal Testing on Admission, Patient Placement
- Pre-procedure (if test not performed within 72 hours and no new symptoms)
- Current inpatients with new infectious symptoms concerning for COVID-19

Huddle Performed for Patients Admitted with Pending Tests
1. Indications for testing
  - Screening Test: Pre-admission/Pre-procedural in an Asymptomatic Patient
  - Diagnostic Test: Symptomatic or Exposed Patients to detect Disease
2. Exposure
  - Prolonged (> 15 minutes), close (< 6 feet) contact with a person who is COVID-positive
  - Residing in an Geographic Region with Widespread Community Transmission
  - Traveled outside of the United States in 14 days prior to admission
3. Patients receiving Aerosol Generating Procedures (AGP)
  - Charge RT and team huddle to determine if AGPs can be held or strategies for risk reduction can be employed pending test results

Review the Following to Determine Precautions for Patients with Pending SARS-CoV-2 Tests*
	Exposure	AGP	Precautions
Asymptomatic (Screening)	No	No	Standard (Review if precautions for alternate infections are required)
	No	Yes**	Expanded; Single negative pressure room, if available. If not able to safely defend in place, transfer to the SIU or PSTU.
	Yes	No	Modified Expanded; Single room with door closed
	Yes	Yes	Expanded; Single negative pressure room, if available. If not able to safely defend in place, transfer to the SIU or PSTU.
Symptomatic (Diagnostic)	No	No	Modified Expanded; Single room with door closed
	No	Yes	Expanded; Single negative pressure room, if available. If not able to safely defend in place, transfer to the SIU or PSTU.
	Yes	No	Modified Expanded; Single room with door closed
	Yes	Yes	Expanded; Single negative pressure room, if available. If not able to safely defend in place, transfer to the SIU or PSTU.
If symptoms and/or exposures are unknown/unclear, assume the patient is symptomatic and/or exposed while the test result is pending. *Asymptomatic and unexposed patients who require an AGP, but have tested negative on admission should remain on standard precautions if repeat testing is needed prior to a procedure.

SARS-CoV-2 Results Available
	No AGP	AGP
COVID Positive	Modified Expanded Transfer to or remain in SIU or PTSU ID consult	Expanded Transfer to or remain in SIU or PTSU ID consult
COVID Negative No Exposure	Droplet and/or Contact based on Symptoms Transfer out of the SIU or PSTU, as indicated
COVID Negative Exposure	Modified Expanded for 14 days from date of last exposure Single Room, door closed	Expanded for 14 days from date of last exposure Transfer to or remain in SIU, PTSU

Guidance for Discontinuation of Precautions

Resources

Posted: March 2020
Revised: March 2020, April 2020, May 2020, June 2020, July 2020, August 2020, September 2020, October 19, 2020, October 26, 2020
Authors: C. Kerman, MD; D, Davis, MD; K, O’Callaghan, MD; K. Chiotos, MD; J. Lavelle, MD; L. Handy, MD; J. Sammons, MD

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Inpatient Clinical Pathway for Screening/Evaluation of Children with Suspected 2019 Novel Coronavirus (COVID-19) Disease

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