Abstract

 
 
 
 Introduction: Patan Academy of Health Sciences (PAHS) emergency department adopted a standard protocol for case management which was further modified to sustain the influx of patient. In standard protocol dengue test was sent for all patient while in modified protocol the test was sent in limited patients. This study was designed to predict the number of investigations that would have been sent using these protocol during the outbreak.
 Methods: This was a cross sectional study conducted at emergency department of PAHS, during a dengue outbreak (September 2019). Patients with a screening test sent and those with a positive screening test were analyzed using regression for the number of dengue screening test sent using standard and modified protocol.
 Results: Total of 10,773 patients visited emergency department from 15 August to 14 October 2019. Suspected dengue was 2567 (23.8%), out of which dengue screening test was positive in 658 patients. Standard protocol was used in phase 1, the median test sent per day was 95.5, if modified protocol had been used the median test would have been 89.0, this was statistically significant. In phase 2 median test sent per day using modified protocol was 60.5, if standard protocol had been continued median test would have been 61.0 per day. It was not statistically significant.
 Conclusions: Modifying protocol according to surge of patient during epidemic is helpful if it is sent early during outbreak. Case management protocols need to be dynamic to manage the surge of patient.
 
 
 
Highlights
Patan Academy of Health Sciences (PAHS) emergency department adopted a standard protocol for case management which was further modified to sustain the influx of patient
Suspected dengue who presented with fever were 2567 (23.8%), out of which dengue screening test was positive in 658 patients
In phase 2 median test sent per day using modified protocol was 60.5(IQR 52.5-66.8), if standard protocol had been continued median test would have been 61.0 (IQR 37.1-79.2)per day
Summary
Patan Academy of Health Sciences (PAHS) emergency department adopted a standard protocol for case management which was further modified to sustain the influx of patient. This study was designed to predict the number of investigations that would have been sent using these protocol during the outbreak. This study is designed to predict the number of investigations that would have been sent if modified protocol[5] or standard protocol had been used throughout the outbreak month. This will help to implement the suitable protocol as soon as outbreak is established in future. In September 2019, Nepal faced dengue outbreak[4], the rising number of cases were managed in different hospitals and emergencies
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