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Updated: Dec 1, 2025
Remote Laboratory Management: Respiratory Virus Diagnostics
Published on: April 6, 2019
Emergency department response to coronavirus disease 2019 outbreak with a fever screening station and "graded
Julia Chia-Yu Chang1,2, You-Hsu Chen3, Meng-Chen Lin3
1Department of Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Insights
A fever screening station and graded risk approach effectively managed coronavirus disease 2019 (COVID-19) patients in an emergency department, reducing workload and preventing nosocomial infections.
Area of Science:
- Emergency Medicine
- Infectious Disease Control
- Public Health
Background:
- The emergence of coronavirus disease 2019 (COVID-19) necessitated rapid adaptations in healthcare settings.
- Emergency departments (EDs) require timely infection control measures to maintain services and prevent disease spread.
- This study details a unique strategy implemented in a Taiwanese medical center.
Purpose of the Study:
- To describe the implementation of a fever screening station (FSS) and a graded approach to patient isolation and testing.
- To evaluate the effectiveness of these measures in managing patients during the COVID-19 outbreak.
- To assess the impact on ED workload and nosocomial infection prevention.
Main Methods:
- Established an FSS outside the ED for initial patient triage.
- Implemented a graded approach to stratify patients into high, intermediate, and undetermined risk categories.
- Utilized risk stratification for isolation and COVID-19 testing protocols.
Main Results:
- Screened 3755 patients, with a significant percentage presenting with fever (54.9%) or respiratory symptoms (35.5%).
- Two patients (0.1%) tested positive for COVID-19, while 127 (3.4%) tested positive for atypical infections.
- The FSS and graded approach facilitated patient flow, reduced ED workload, and enabled efficient resource allocation for isolation.
Conclusions:
- Rapid response strategies, including FSS and graded risk assessment, are crucial for EDs during outbreaks.
- The combined approach effectively managed patient influx, reduced workload, and mitigated the risk of nosocomial infections.
- Risk stratification is vital for preventing healthcare-associated transmission and optimizing the use of medical resources.
Background:
Ever since coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, in December 2019, it has had a devastating effect on the world through exponential case growth and death tolls in at least 146 countries. Rapid response and timely modifications in the emergency department (ED) for infection control are paramount to maintaining basic medical services and preventing the spread of COVID-19. This study presents the unique measure of combining a fever screening station (FSS) and graded approach to isolation and testing in a Taiwanese medical center.
Methods:
An FSS was immediately set up outside the ED on January 27, 2019. A graded approach was adopted to stratify patients into "high risk," "intermediate risk," and "undetermined risk" for both isolation and testing.
Results:
A total of 3755 patients were screened at the FSS, with 80.3% visiting the ED from home, 70.9% having no travel history, 21.4% having traveled to Asia, and 10.0% of TVGH staff. Further, 54.9% had fever, 35.5% had respiratory symptoms, 3.2% had gastrointestinal symptoms, 0.6% experienced loss of smell, and 3.1% had no symptoms; 81.3% were discharged, 18.6% admitted, and 0.1% died. About 1.9% were admitted to the intensive care unit, 10.3% to the general ward, and 6.4% were isolated. Two patients tested positive for COVID-19 (0.1%) and 127 (3.4%) tested positive for atypical infection; 1471 patients were tested for COVID-19; 583 were stratified as high-risk, 781 as intermediate-risk, and 107 as undetermined-risk patients.
Conclusion:
Rapid response for infection control is a paramount in the ED to confront the COVID-19 outbreak. The FFS helped divide the flow of high- and intermediate-risk patients; it also decreased the ED workload during a surge of febrile patients. A graded approach to testing uses risk stratification to prevent nosocomial infection of asymptomatic patients. A graded approach to isolation enables efficient allocation of scarce medical resources according to risk stratification.
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