Denver Health tests all patients being admitted to the hospital for COVID-19, regardless of the presence of symptoms. Our goal is to identify and isolate COVID-19 patients appropriately and early in their hospital stays in order to minimize exposure to employees and other patients.
The testing algorithm below (created on 7/27/20) reflects some changes from the previous algorithm that had been in place since May. Changes include: Separating the cohort of patients that need tests for discharge and leaving those specifics vague since the exact process routinely changes. The processes for testing for surveillance and testing for suspected are further separated, as is the patient flow to admission.
ED/AUCC/OBSR COVID-19 Testing Algorithm
Click on algorithm to enlarge
1) Patients with ≥2 points – test these patients and use Specialized Respiratory Isolation while the test is pending. Specifically, these patients should be placed into a negative airflow room and healthcare workers should wear an N95 mask, gown, gloves, and eye protection when entering the room.
2) Patients with 0-1 points –
a. Perform a COVID-19 surveillance test
b. Do not hold patient in ED for results
c. Admit to a non-COVID-19 room placement
d. Use eye protection, surgical mask, gown, and gloves to collect the specimen. For other circumstances, PPE should include surgical mask alone when entering the room
e. Only escalate to Specialized Respiratory Isolation if the test is positive
Frequently Asked Questions
How has the process changed for admitting a patient with symptoms of COVID-19?
This process has not changed. Providers will order a COVID-19 test and patients should be placed in a private negative airflow isolation room while the test is pending. Specialized respiratory isolation should be used (N95, eye protection, gown, gloves) while the test is pending and continued if it is positive.
How has the process changed for admitting patients who are not suspected of having COVID-19?
These patients should all receive a COVID-19 Surveillance Test at admission, both those new admissions as well as those who are admitted at the current time. The order at admission will be prompted if a COVID-19 test has not been performed in the previous 48 hours. The order for existing patients will not be prompted but should be placed by providers. Those patients who are being discharged today do not need a test. Providers will choose “surveillance” in the order. These patients should be admitted per routine process. Specifically,
• They do not require a private room
• They do not require a negative airflow isolation room.
• They do not require specialized respiratory isolation.
• They should not be kept in the ED until the test is resulted.
• Only if the test becomes positive will they be transferred to a negative airflow isolation room with specialized respiratory isolation.
How can you tell the difference between the clinical (suspected) and surveillance COVID-19 tests?
There are two ways for you to distinguish between patients on your floor who have a clinical test vs. a surveillance test.
First, charge nurses, ACC, and nursing leadership should see the following on their unit manager:
Second, all nurses and providers should see the following in the orders to confirm that the test is a surveillance test (i.e. not requiring specialized respiratory isolation):
Third, the ED track board for non-ED providers will show the COVID-19 test reason in a new column.
Fourth, staff can search and add a COVID-19 column to the Patient List.
What should I do about current inpatients who have not had a surveillance test?
We recommend a surveillance COVID-19 test for all inpatients who have not yet been tested for COVID-19. Patients who were already tested earlier in their hospital course do not need a second test.
Why not hold patients in the ED until the COVID-19 surveillance test is resulted?
The current test for COVID-19 takes approximately 12 hours to be resulted. It is not practical to hold patients in the ED for this duration of time.
Won’t this strategy result in COVID-19 patients going to non-COVID-19 floors?
Patients with 0-1 points have a low pretest probability of having infection; therefore, the number of patients who come back as being positive should be fairly low. However, there will be cases in which the patient tests positive for COVID-19 after placement on a non-COVID-19 ward. This will result frustration, as a result of bed shuffling, and anxiety amongst staff. These feelings are completely justified. Please realize, however, that patients such as these are currently in our facility and are undiagnosed. By obtaining this additional information, we are increasing the safety of both staff and other patients.
How will I be able to tell which patient is having a surveillance test vs. a symptom-based test?
This information will be visible within the order for testing (see screenshot below). It can also be seen by nurse managers, charge nurses, and house supervisors. More information will be coming specifically to those employees on how to visualize the information.
What PPE should be worn for patients who get a COVID-19 surveillance test?
To collect the COVID-19 surveillance test, it is most appropriate to wear a surgical mask, gown, gloves, and eye protection. For all other entries to the room of a patient who has a COVID-19 surveillance test, please wear a surgical mask alone.
Should I notify another patient if their roommate has a positive COVID-19 surveillance test? Are there any precautions needed for the roommate?
No, specific notification of the patient’s roommate is unnecessary as Denver Health already has disclosed to patients that they may be at risk of COVID-19 exposure given the widespread transmission occurring in our community. Roommates are separated by >6 feet and a physical barrier (closed curtain). Therefore, a roommate is not at particularly high risk of developing COVID-19 and should not be treated any differently.
Can orthopedics and general surgery admit patients while the COVID-19 surveillance test is pending?
Yes, orthopedics and general surgery can and should admit patients while the COVID-19 surveillance test is pending. No additional precautions are needed for these patients unless test results positive.
Does this testing strategy apply to obstetrics and pediatrics?
Yes, this testing strategy applies to all patients being admitted to Denver Health.
Can I see screenshots of what this will look like?
Patient with Pending Suspected Test:
Patient with Pending Surveillance Test: