Coronavirus — Guidance for Admission Locations for ED Patients — Clinical Pathway: Emergency

Admitting ED Patients: Consider Symptoms, Exposure, Percent Positivity among CHOP Patients

Definition of Symptoms and COVID Suspected Patients
COVID Symptoms	Concerning Symptoms Cough (sustained) Shortness of breath Difficulty Breathing Loss of taste or smell Symptoms non-specific to COVID Fever Fatigue Chills/rigors Headache Myalgia Sore throat Congestion/rhinorrhea Nausea Vomiting/diarrhea
COVID Suspected	≥ 1 Concerning symptom or ≥ 2 Non-specific symptom categories present Without evidence of another explanatory non-respiratory viral or bacterial illness Examples: Cellulitis, classic Hand-foot-mouth, GAS pharyngitis, UTI Exceptions: Bronchiolitis, pneumonia
Exposure	Full Exposure Definition with Examples Prolonged (> 15 minutes), close (< 6 feet) contact with a person who is COVID-positive Spent 15 cumulative minutes within 6 ft of a symptomatic or pre-symptomatic person who is COVID-positive

ED EPIC COVID Testing Order

For patients likely to be admitted, send Rapid Test as soon as possible. Admitted patients need a PCR COVID test within the preceding 72 hours; can consider repeat testing if there are new symptoms.

Encourage patients who are discharged to sign-up for MyChop; ED APPs call families with Positive Tests.

Use General COVID Discharge Instructions (In EPIC Fever DC Smartset); also provide Return to Sports after COVID for General Pediatricians.

			Specimen	TAT
Admitted Patients	RAPID Pre-admission/procedure Screening SARS-CoV-2 Test	No symptoms, no exposure and requires admission/procedure	Anterior nares	2 hours
Admitted Patients	RAPID Diagnostic SARS-CoV-2 Test	Symptoms or exposure		2 hours
Discharged Patients	Priority SARS-CoV-2 Test	Symptoms		6-8 hours

Admission Guidance for Patients and COVID Testing
Admitting Patients with Pending Test Results
Admit to a standard single room with pending test results: Asymptomatic, exposed or unexposed Symptomatic + unexposed Symptom definition: Fever and/or other symptoms including respiratory symptoms
Remain in ED: Patients receiving AGPs^* Symptoms + exposed Concern for MIS-C *^Note:** Critically-ill patients can be transferred to PICU Isolation Rm with pending results

Aerosol-Generating Procedures

References

Ng OT, Marimuthu K, Chia PY, et al. SARS-CoV-2 Infection among Travelers Returning from Wuhan, China. N Engl J Med. 2020.
Hoehl S, Berger A, Kortenbusch M, et al. Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China. N Engl J Med. 2020.
Li R, Pei S, Chen B, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). Science. 2020.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.