Screening and managing of suspected or confirmed novel coronavirus (COVID-19) patients: experiences from a tertiary hospital outside Hubei province

Objectives

To report our experiences screening and managing patients with suspected or confirmed novel coronavirus (COVID-19) disease using a hospital-specific protocol.

Design

Longitudinal cohort study.

Setting

A 1,200 bed tertiary care teaching hospital in Chengdu, Sichuan, China.

Participants

802 adults presenting to hospital with concerns of having COVID-19, 1,246 inpatients and 2,531 hospital visitors.

Interventions

Screening and management of patients using a hospital-specific protocol, which included fever triage, monitoring visitors and patients, emergency response, personnel training for healthcare team members, health education for patients and family, medical materials management, disinfection and wastes disposal protocols.

Results

Between 23 January and 28 February 2020, 73 people were identified as having fever plus respiratory signs with/without a history of exposure and were tested for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by our hospital lab using RT PCR. Forty-five of these 73 people were subsequently excluded based on one negative RT PCR result plus positive results to quick screening tests for flu or other respiratory viruses. The remaining 28 people received a second RT PCR test 24 h later. Three people were confirmed positive for COVID-19 based on two consecutive positive RT PCR tests whilst 25 people were excluded based on two consecutive negative tests. The three COVID-19 confirmed cases received non-critical care. There were no new infections of medical staff or new infections of other hospital inpatients.

Conclusions

A hospital-specific protocol for screening and management is necessary for reliably identifying suspected or confirmed COVID-19 patients during an outbreak. All three cases were detected as a result of vigilant monitoring of hospital visitors. Whilst screening out-patients presenting to a fever clinic remains important, monitoring visitors must not be overlooked.

Strengths and limitations of this study

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  We report a hospital-specific protocol used to screen and manage people presenting to our hospital fever clinic, inpatients and visitors during an outbreak of novel coronavirus (COVID-19) pneumonia in Chengdu, Sichuan province.

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  Key components of the protocol included: a three-level fever triage process; monitoring visitors and inpatients, formation of an emergency response team for COVID-19, personnel training for healthcare team members, health education for patients and family, medical materials management, and disinfection and wastes disposal protocols.

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  The ability to test nucleic acid of SARS-CoV-2 using RT PCR in the hospital greatly shortened the time from the detection of patients to diagnosis, and was beneficial to the control of the transmission of the SARS-CoV-2.

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  Although our process detected few patients, comparison with other processes, when they are published, will allow the identification of the optimal approach for screening and management.

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  We suggest that if all resources had been focused on screening people through our fever clinic, we would have missed important in-hospital risks of transmitting COVID-19: The detection of a hospital visitor with COVID-19 led to the detection of an inpatient with COVID-19.