Authors (including presenting author) :
Chan Kin Pang Alexander
Affiliation :
M.B., Ch. B. (CUHK), MRCSEd
Resident, Accident and Emergency Department, Tseung Kwan O Hospital
Introduction :
The Coronavirus Disease 2019 (COVID-19) pandemic, caused by SARS-CoV-2 and was reported to start in China since late December 2019, had posed great stress to medical systems around the world, including Hong Kong, pushing the system towards the edge of meltdowns. Considering the close relationship and interaction with mainland China and other parts of the world, Centre of Health Protection (CHP) had started enhanced surveillance for suspected cases on 31 December 2019[1,2]. With the first confirmed case reported in Hong Kong on 22 January 2020 [3], the Accident and Emergency Department (AED) around Hong Kong upholds its long-standing role as the first point of contact of all patients including those suspected and confirmed cases.
In response to the pandemic, Emergency response level was activated on 25 January 2020 [4,5], and a tier system for stratification of cases was set up on 31 January 2020 [Appendix 1]. In the beginning, in our hospital, most Tier 1 patients were admitted to isolation wards for isolation and diagnostic testing. With the evolvement of the pandemic, a large surge of suspected and confirmed cases from single-digit per day to more than 35 cases per day was noted in mid-March 2020 [6-15]. At that juncture, given the high occupancy of isolation facilities and large caseload [16,17], admission for isolation and testing was no longer a feasible option. A Triage and test (T&T) model was then developed and adopted since 21 March 2020 as the solution: Tier 1 cases, who are stable and not requiring active resuscitation, are triaged and tested for SARS-CoV-2 by saving relevant specimen (including Nasopharyngeal swabs (NPS); Nasopharyngeal Aspirate (NPA); Throat swabs and/or Deep Throat Saliva) in AED of Tseung Kwan O Hospital (TKOH). Those positive cases will be admitted, while those patients who are tested negative will be managed accordingly. If the patient who was tested negative were fit for outpatient management, they will be discharged with the treatment provided.
Objectives :
This research aims to, firstly, review the effect of the T&T strategy on admission rate, length of stay in AED and hospital; secondly, the incidence of COVID-19 in a certain period of time; thirdly, the reattendance rate of the patient, and the rate of change in result from negative to positive; the portion of patients requiring intubation or intensive care (Defined as admission to Intensive care unit (ICU), and finally to review the effect of the T&T strategy on the mortality rate of cases confirmed with COVID-19.
Methodology :
This single-centered, cohort study compared patients who were suspected to have COVID-19 attending AED, Tseung Kwan O Hospital, who was always admitted and requiring isolation, between 25 January to 20 March 2020, with the patient who attended the same AED and was manage with T&T strategy between 21 March to 10 May 2020.
Result & Outcome :
For primary outcomes, implementation of the T&T strategy can significantly reduce the admission rate (Control Group 95.0% vs T&T Group 22.4%, χ2 = 241.3, p < 0.001); Length of stay in hospital is significantly shorter (Control group median 1815 minutes vs T&T group median 548 minutes, p < 0.001). Length of stay in AED is significantly longer (Control group median 111.5 minutes vs T&T group median 443.0 minutes, p < 0.001).
For secondary outcomes, incidence rate of COVID-19 among two groups are comparable (Control group 2.22% vs T&T group 2.88%, p = 0.777); The reattendance rate of patients within 14 days are comparable (Control group 3.89% vs T&T Group 5.75%, χ2 = 0.823, p = 0.364); Incidence rate of intubation are comparable (Control group 0.005% vs T&T group 0%, p = 0.365); Admission rate to ICU care are comparable (Control Group 0.6% vs T&T Group 0.3%, p =1.00). Rate of change in result from negative to positive within 14 days, and Mortality between two groups are both zero.
