Triage

Criteria for Testing

Testing capacity has been in flux (see Module 3: Testing Capacity for updates), with resultant changes in testing eligibility protocols. The Massachusetts Department of Public Health (MA DPH) publishes updated guidelines with criteria for COVID-19 testing (see below for version as of 4/2/2020). It differentiates between populations recommended to be tested at state versus commercial laboratories.

Remote Screening

Screening can occur remotely through a telephone/virtual visit by guidelines similar to above. Drive-through testing sites are expanding across the country, including Massachusetts, and often require that patients fill out an online screening assessment to determine eligibility. With in-house testing increasing at hospitals, institutions are developing their own testing eligibility protocols (see below). The Cleveland Clinic has produced an online tool allowing patients to self-assess for infection risk, with care recommendations based on risk level.

Triage Guidelines by Hospital

Testing: Hospitals have generally been outlining testing criteria for ambulatory vs emergency department or inpatient settings. Partners-specific guidelines are available here (note: requires Partners credentials). BILH provides guidelines on their website. Cambridge Health Alliance guidelines are available here (note: requires CHA credentials). Of note, most protocols are initially symptom-based (except for select populations such as transplant patients or requiring urgent airway surgery), followed by a prioritization list for symptomatic patients or staff. These reflect a balance of clinical/operational needs for testing and resource availability.

Clinical Triage: For a discussion of clinical triage guidelines, see Module 1: Triage Guidelines.

Thought question:

For a low-risk patient who may not fall under the recommendations to get tested for COVID-19, but who does want to get tested, how might a healthcare worker navigate the conversation about the utility of testing amongst those at highest risk?