Assessing Patient Ability to Exercise COVID-19 Transmission Based Precautions: A Proposed Clinical Tool

Abstract

Clinical decision-making during the present pandemic has challenged healthcare providers to the limits of their endurance. Inpatient facilities are discharging patients who are positive for the COVID-19 infection, based on testing, and who may still be positive but have symptoms that have remitted. Even medically stable patients may not be able to exercise basic transmission-based precautions such as handwashing or wearing a face mask, and may increase the risk of infection spread to others upon discharge. This can present challenging decisions about when, how, and where to discharge COVID inpatients. This article addresses the behavioral health aspects of this problem, offering background information and proposing creation of a Transmission Based Precautions Inventory. This clinical tool will use chart information and a clinical interview to assess the capability of patients upon discharge to exercise the appropriate behavior-based precautions to prevent the spread of any contagious infection. The discussion includes an exemplar that illustrates the dilemma, followed by other metrics for scoring and development of the tool. Administration time of the tool would be approximately 15-20 minutes and responses would score immediately to inform discharge decisions. The need for such a tool is current; however, the usefulness of an efficacious inventory would persist beyond the present pandemic. In the conclusion, the author invites reader feedback to inform the development and implementation process.