Authors (including presenting author) :
Chan PF(1), Lai KPL(1), Hui YS(1), Fung SCK(2), Chao DVK(1)
Affiliation :
(1)Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital
(2)Department of Pathology, United Christian Hospital
Introduction :
During COVID-19 pandemic, there is global threat by the rapid spread of the disease. Although Hong Kong had contained the number of confirmed cases to a relatively small number, there were continuous community outbreaks. In GOPCs, prompt detection and effective triage and cohort of potentially infected patients are essential to reduce community outbreaks and prevent nosocomial infections.
Objectives :
1. To implement an enhanced patient triage and cohort system in KEC GOPCs.
2. To review the outcomes of the new system.
Methodology :
In usual operation of GOPCs, patients presented with fever and influenza-like symptoms together with epidemiological criteria would be triaged and then assessed in the fever room. However, a large proportion of patients infected with COVID-19 would have no fever or epidemiological link. By using the original triage arrangement, some infected patients would not be triaged out and mixing them with other visitors in a crowded waiting area would put other people at risk.
In facing a serious infectious threat, healthcare workers would worry about close contact with ‘invisible’ infectious patients and request escalated levels of PPE for patient care at even ‘non-high risk’ areas. In order to prevent nosocomial infections, an enhanced triage and cohort system was implemented in all KEC GOPCs in February 2020 as follows:
A. Triage and cohort
All patients and visitors would be screened for fever and acute respiratory symptoms at the triage station. All patients screened positive including patients with epidemiological link and feeling unwell would be triaged according to the latest FTOCC triage checklist and cohorted in a separated Special Waiting Area.
B. Consultation
Each clinic would arrange one designated doctor in each session to assess and manage all cohorted patients in the fever room with recommended PPE.
Result & Outcome :
Results:
There were 658,201 patient attendances at the eight GOPCs from 21 February to 31 December 2020, 45,423 patients (6.9%) were triaged and cohorted. Only 3,942 (8.7%) patients had fever. Up to 31 December 2020, 63 patients from our GOPCs were confirmed to have COVID-19 infection and 69% of them had no fever. No staff was quarantined or required medical surveillance due to unprotected contacts and there was no nosocomial infection. A large number of PPE were also saved.
Conclusion:
A robust triage and cohort system is of upmost importance to help early detection of suspected COVID-19 cases, reduce the risk of community outbreak and nosocomial infections, and to ensure effective use of PPE in GOPCs.
