Problem: During the beginning of the novel SARS CoV-2 pandemic there was no standardized way to manage the triage of primary care (PC) patients at UC San Diego Health presenting with COVID-like symptoms. It was imperative the nurse triage leadership team develop an appropriate triage protocol for assessment and disposition of patients including providing access to SARS CoV-2 testing. This protocol would aid in the prevention of our healthcare system becoming overrun, preserve healthcare resources, provide access to testing when medically appropriate, and reduce the spread of disease.
Description of the change: As part of the planning stage, the team created a triage protocol that was based on testing availability and included symptoms criteria. As an interim measure prior to the development of a formal Schmitt and Thompson protocol for COVID-19, the team created an EpicPIC SmartPhrase based on CDC guidelines and physician discretion. The registered nurse would assess the patient and disposition the patient based on acuity (e.g., emergency department, urgent care, and home care advice). If the patient was low acuity, the RN could also place and order for a COVID-19 test at one of the drive-thru facilities. The protocol aligned with the PC physician group priority of keeping patients out of clinics while ensuring access to urgent care if necessary and ensure early detection of COVID-19 positive patients in the community.
Results: After review of the data since May 2020, the overall call volume to PC nurse triage increased 23%. Between October 2020 and March 2021, the COVID protocol (includes adult and pediatric PC patients) was utilized 23% of our total calls. The COVID protocol home care advice increased from 13% to 36%. Aligned with the COVID protocol, no patients were dispositioned to a PC clinic while 44 to 60% were provided home care advice to stay home and complete a COVID test at a UCSDH drive-through location. On average, the percentage of patients who call into the PC nurse triage department and dispositioned to ER is 11%; however, within the COVID protocol, it was decreased to 6%, demonstrating a reduction in the utilization in ER resources.
Implications: The standardization of how nurses assessed, managed, and educated COVID-19 symptoms ultimately reduced the spread of COVID-19 in the community. Overall it reduced the burden to the clinics, protected testing resources, conserved PPE during a national shortage, and preserved terminal cleaning resources.
Sustainability: Integrating Schmitt and Thompson protocol into EHR with precise mapped dispositions and applicable home care advice for any future needs.