PRP086: Evaluation of a Triage Protocol for COVID19 Testing in an Immediate Care Setting
Lauren Oshman, MD, MPH, MPH; Amanda Caplan, MD; Sean David, MD, MSc, DPhil, FAAFP; Rabeeya Khalid, MD; Raabiah Ali, MPH
Context: NorthShore University HealthSystem developed an in-house SARS-CoV-2 PCR (polymerase chain reaction) test as part of our response to COVID-19 and initiated ambulatory testing on March 12, 2020. CDC and Illinois Department of Health criteria were used to develop a telephone triage protocol to risk-stratify patients seeking medical care for symptoms of COVID-19. The purpose of this study is to evaluate the performance of the telephone triage protocol at identifying patients at higher and lower risk for a positive SARS-CoV-2 PCR test, ER hospital and ICU utilization, intubation and death. Results may inform organizations developing screening protocols for ambulatory COVID-19 testing. Objective: The primary objective is to compare percentage and variables associated with a positive SARS-CoV-2 test in low and high risk triage cohorts. Key secondary objectives are to describe differences in ER, hospital, and ICU utilization, intubation and death and to describe reasons clinicians offered a SARS-CoV-2 test to low-risk patients. Study design: Quality improvement quasi-experimental cohort design involving data of key COVID-19 risk classification, exposure, and outcome information. Setting: Four Immediate Care clinics designated as COVID-testing site within an integrated health system in the Northern suburbs of Chicago. Population: Approx. 2,000 patients with COVID-19 symptoms and visits between 3/22 to 3/28/2020. Exclusion criteria: asymptomatic patients and those with visits outside of study dates. Intervention: All patients received an evaluation by a clinician. High risk patients received a SARS-CoV-2 test. Clinicians recommended SARS-CoV-2 test to some low risk patients. Outcome Measures: Positive SARS-CoV-2 test, ER, hospital, and ICU utilization, intubation and death within 2 weeks of the date of the index Immediate Care visit. Anticipated Results: High-risk patients will be more likely to have a positive SARS-CoV-2 test and associated outcome measures compared to low-risk patients. Physicians will identify risk factors missing in the triage protocol that lead them to reclassify low-risk patients as high-risk and offer testing. Anticipated Conclusions: The triage protocol performed well to identify outcomes of interest. This study will inform evidence-based changes to the triage protocol moving forward. Other organizations may adapt the results of this study to determine which patients have a very low probability of a positive test.