Abstract
BackgroundCoronavirus disease (COVID-19) is a global pandemic that has placed a significant burden on health care systems in the United States. Michigan has been one of the top states affected by COVID-19.ObjectiveWe describe the emergency center curbside testing procedure implemented at Beaumont Hospital, a large hospital in Royal Oak, MI, and aim to evaluate its safety and efficiency.MethodsAnticipating a surge in patients requiring testing, Beaumont Health implemented curbside testing, operated by a multidisciplinary team of health care workers, including physicians, advanced practice providers, residents, nurses, technicians, and registration staff. We report on the following outcomes over a period of 26 days (March 12, 2020, to April 6, 2020): time to medical decision, time spent documenting electronic medical records, overall screening time, and emergency center return evaluations.ResultsIn total, 2782 patients received curbside services. A nasopharyngeal swab was performed on 1176 patients (41%), out of whom 348 (29.6%) tested positive. The median time for the entire process (from registration to discharge) was 28 minutes (IQR 17-44). The median time to final medical decision was 15 minutes (IQR 8-27). The median time from medical decision to discharge was 9 minutes (IQR 5-16). Only 257 patients (9.2%) returned to the emergency center for an evaluation within 7 or more days, of whom 64 were admitted to the hospital, 11 remained admitted, and 4 expired.ConclusionsOur curbside testing model encourages the incorporation of this model at other high-volume facilities during an infectious disease pandemic.
Highlights
The first case of human-to-human transmission of coronavirus disease (COVID-19) in the United States was reported on January 30, 2020 [1]
Patients were registered as active emergency centers (EC) patients, and documentation was done via the electronic medical record (EMR), including a provider note
The median time for the entire process was 28 minutes (IQR 17-44)
Summary
EC curbside services were implemented at all 8 hospitals at Beaumont Health during the COVID-19 pandemic. Patients were registered as active EC patients, and documentation was done via the electronic medical record (EMR), including a provider note All aspects of this process were compliant with the Emergency Medical Treatment and Labor Act and adhered to the Centers for Medicare & Medicaid Services guidelines [5] regarding medical screening exams conducted in an alternate site of care. All patients seeking emergency care were initially asked by the EC tech personnel if testing was the purpose of their visit, and if so, they were sent to the curbside location. To avoid long wait times, we opened multiple triage and screening locations based on the surge of patients and streamlined documentation, increased staffing, and processed in parallel instead of serially. PPE comprised the following: N95 mask, surgical mask, gown and gloves
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