Immersion in an emergency department triage center during the Covid-19 outbreak: first report of the Liège University hospital experience

Gilbert, Allison; Brasseur, Edmond; Petit, Meredith; Donneau, Anne‐Françoise; Diep, Anh Nguyet; Campbell, Suzanne; Servotte, Jean-Christophe; Piazza, Justine; Ancion, A; Gensburger, M; D’Orio, Vincenzo; Ghuysen, Alexandre

doi:10.1080/17843286.2020.1778348

Cited by 9 publications

(7 citation statements)

References 12 publications

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“…Several studies from different countries [5,[16][17][18] indicate that triage and work-up in specific areas outside the classical ED, as well as the use of complete protection equipment please, remove s play a key role in reducing intra-hospital spreading of SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 99%

“…This was made even more challenging by the fact that pediatric patients with confirmed SARS-CoV-2 infection seem to present with mild, nonspecific symptoms [1][2][3][4], with epidemiological risk factors (especially the familial context) being of paramount importance to identify affected children [1]. Another important factor influencing emergency care has been the limited possibility of primary care facilities to perform physical evaluation in subjects with febrile or respiratory conditions, due to the lack of appropriate protection equipment and dedicated spaces [5].…”

Section: Introductionmentioning

confidence: 99%

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Infection control strategy and primary care assistance in Campania region during the national lockdown due to COVID-19 outbreak: the experience of two tertiary emergency centers

et al. 2021

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Background COVID-19 pandemic has markedly affected emergency care, due to sudden limitation of health care capacity by general practitioners (GP) and urgent need for infection control strategies. We evaluated the activity of the Emergency Department (ED) during the national lockdown (March 8–April 30), as well as the outcomes of our infection control strategy. Results Despite a reduction in access by one fifth, a proportion of febrile patients comparable to 2019 was seen (829/2492, 33.3% vs 4580/13.342, 34.3%, p = 0.3). Diagnostic swab for COVID-19 was performed in 25% of patients, especially in subjects with co-morbidities or multiple access. Six infected cases were identified, all presenting with febrile disease. Only two positive patients fulfilled the criteria for diagnostic swab provided by the Italian Health Authorities, because of close contact with suspected or confirmed cases. The rate of admission for febrile or respiratory conditions was higher than the same period of 2019 (33.4% vs 25.9%, p < 0.0001). None of the 105 health-care professionals working during the study time lapse exhibited anti-SARS-CoV-2 seroconversion. Among the 589 patients with information available, 54.9% declared no medical consultation at all prior to coming to ED, while only 40 (of which 27 with fever) had been examined by their GP before coming to ED. Nevertheless, 35.6% of the cases were already taking medications. None of the 9 patients requiring intensive care reported recent pediatric consultation, despite symptoms duration up to 30 days. Conclusion Our results provide evidence that the reduced capacity of primary care facilities during the national lockdown may have caused a high rate of self-medication as well as a delayed provision of care in some patients. Identification of pediatric patients affected with SARS-CoV-2 infection remains a challenge because of the absence of reliable predictive factors. Finally, the use of specific triage centers, with dedicated pathways to diagnose SARS-CoV-2 infection, trace contacts and allow adequate care after swabs, is effective in preventing spreading of the infection.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Infection control strategy and primary care assistance in Campania region during the national lockdown due to COVID-19 outbreak: the experience of two tertiary emergency centers

et al. 2021

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“…During the study period, all patients directed to the triage centers were eligible to be included. Pediatric patients (age <16 years old) were excluded because the university centers created a specific pediatric ward with particular procedures [12].…”

Section: Database and Study Settingsmentioning

confidence: 99%

“…At the end of 2020, due to the high morbidity of SARS-CoV-2 at world level (ffi 84 millions of people including ffi 0.65 million in Belgium; https://www.worldometers.info/coronavirus/), the severity of clinical presentation in patients (severe acute respiratory syndrome) and the limited laboratory diagnostic capacities, emergency departments (EDs) have been overwhelmed by the flow of COVID-19 suspected patients in the pandemic context [12]. Moreover, the use of dedicated triage centers is known to offer a management option in disaster situations [13].…”

Section: Introductionmentioning

confidence: 99%

Clinical decision support tool for diagnosis of COVID-19 in hospitals

Saegerman

Gilbert²,

Donneau

et al. 2021

PLoS ONE

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Background The coronavirus infectious disease 19 (COVID-19) pandemic has resulted in significant morbidities, severe acute respiratory failures and subsequently emergency departments’ (EDs) overcrowding in a context of insufficient laboratory testing capacities. The development of decision support tools for real-time clinical diagnosis of COVID-19 is of prime importance to assist patients’ triage and allocate resources for patients at risk. Methods and principal findings From March 2 to June 15, 2020, clinical patterns of COVID-19 suspected patients at admission to the EDs of Liège University Hospital, consisting in the recording of eleven symptoms (i.e. dyspnoea, chest pain, rhinorrhoea, sore throat, dry cough, wet cough, diarrhoea, headache, myalgia, fever and anosmia) plus age and gender, were investigated during the first COVID-19 pandemic wave. Indeed, 573 SARS-CoV-2 cases confirmed by qRT-PCR before mid-June 2020, and 1579 suspected cases that were subsequently determined to be qRT-PCR negative for the detection of SARS-CoV-2 were enrolled in this study. Using multivariate binary logistic regression, two most relevant symptoms of COVID-19 were identified in addition of the age of the patient, i.e. fever (odds ratio [OR] = 3.66; 95% CI: 2.97–4.50), dry cough (OR = 1.71; 95% CI: 1.39–2.12), and patients older than 56.5 y (OR = 2.07; 95% CI: 1.67–2.58). Two additional symptoms (chest pain and sore throat) appeared significantly less associated to the confirmed COVID-19 cases with the same OR = 0.73 (95% CI: 0.56–0.94). An overall pondered (by OR) score (OPS) was calculated using all significant predictors. A receiver operating characteristic (ROC) curve was generated and the area under the ROC curve was 0.71 (95% CI: 0.68–0.73) rendering the use of the OPS to discriminate COVID-19 confirmed and unconfirmed patients. The main predictors were confirmed using both sensitivity analysis and classification tree analysis. Interestingly, a significant negative correlation was observed between the OPS and the cycle threshold (Ct values) of the qRT-PCR. Conclusion and main significance The proposed approach allows for the use of an interactive and adaptive clinical decision support tool. Using the clinical algorithm developed, a web-based user-interface was created to help nurses and clinicians from EDs with the triage of patients during the second COVID-19 wave.

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“…Establishment of triage center for filtration of COVID suspected patients can effectively reduce the probability of corona virus transmission and cause safer diversion of Covid patients to specific hospital department [25,26]. INOR has also followed the policy of not entertaining the COVID-19 to minimize the probability of virus spread to other patients and hospital staff.…”

Section: Establishment Of Triage Centermentioning

confidence: 99%

The Safeguard measures for mitigating the impact of COVID-19 on radiotherapy services in a Cancer Hospital: A resource-constrained approach

Gul

Hussain

RIAZ

et al. 2022

IJIST

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This article suggests the preventive measures for healthcare department (particularly radiotherapy department) to reduce the probability of corona virus transmission with a resource constrained approach without affecting the work flow. COVID-19 has affected the patients as well as staff of radiotherapy department leaving a severe negative impact on the financial resources of INOR cancer hospital, Abbottabad. Multiple preventive measures have been taken to reduce the probability of spreading the coronavirus while pursuing the timely treatment of radiotherapy patients without compromising their oncological outcomes. In this context, a triage center was established to filter out the Covid suspected/confirmed patients to reduce the risk of infection to other patients and staff. Social distancing was ensured by making amendments in patient gathering areas. Also extensive ventilation and disinfection procedures were adopted to clean the surfaces. Following these measures, patient flux did not show any considerable decrease in second, third and fourth wave as compared to first wave when patient flux reduced to about less than 25 %. Preventive measures were also taken for the employees by ensuring them to wear personal protective equipment during office hours. To further reduce the probability of contact, telemedicine was adopted for patients where possible. All employees were made to be fully vaccinated by July 2021 resulting in 100 % reduction in new cases among INOR employees in the following fourth COVID wave. Owing to these stringent measures taken to fight against coronavirus, ratio of contracting the coronavirus among the employees and patients of INOR has been found <10% overall in this pandemic, While no mortality has been reported so far.

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Immersion in an emergency department triage center during the Covid-19 outbreak: first report of the Liège University hospital experience

Cited by 9 publications

References 12 publications

Infection control strategy and primary care assistance in Campania region during the national lockdown due to COVID-19 outbreak: the experience of two tertiary emergency centers

Infection control strategy and primary care assistance in Campania region during the national lockdown due to COVID-19 outbreak: the experience of two tertiary emergency centers

Clinical decision support tool for diagnosis of COVID-19 in hospitals

The Safeguard measures for mitigating the impact of COVID-19 on radiotherapy services in a Cancer Hospital: A resource-constrained approach

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