129 The Safety of Rapid Triage in a Coronavirus Epicenter

Abstract

The COVID-19 pandemic has strained health care systems with massive influxes of potentially infectious patients with a respiratory virus. As the epicenter of COVID-19 in the United States, NYC public hospitals were strained well past their limits. Rapid triage, assessment, and disposition is essential in providing safe and appropriate care in a disaster scenario. Multiple studies have shown length of stay times as well as patient elopements improved with a brief physician assessment in triage. Our objective was to determine if rapid assessment medical screening exams are safe and effective means to decompress overcrowded waiting rooms during a respiratory pandemic. All patients presenting to Elmhurst Hospital Center during peak capacity were rapidly assessed by board certified emergency physicians in the waiting room in lieu of formal triaging processes. Each medical screening exam was expected to last no longer than 5 min. In an institutionally approved IRB study, demographic data, chief complaint, medical comorbidities, and a full set of vitals were collected and recorded. Patients were then triaged to the emergency department or instructed to return home to self-quarantine with a comprehensive quarantine instructional packet. Patients sent home were contacted by nursing staff periodically to monitor their health status. Data was collected on patient returns, clinical status, and ultimate disposition. 219 patients were followed after a brief medical screening exam. 162 patients were discharged directly from the waiting room. Out of the discharged patients 14 (9%) returned to an HHC emergency department, and 3 (2%) of those patients ultimately required admission to the hospital. Based on preliminary data, rapid assessment by board certified emergency physicians appears to be a safe and effective means to risk stratify all comers during a respiratory pandemic scenario. Patients who appear well, do not have significant comorbidities, and present with oxygen saturations above 95% can reasonably be reassured and sent home. Such processes are easily reproducible and can be rapidly implemented in times of mass patient influxes.