Patients presenting for hospital‐based screening for the coronavirus disease 2019: Risk of disease, and healthcare access preferences

  1. Amanda Rojek
  2. Martin Dutch
  3. Daniel Peyton
  4. Rachel Pelly
  5. Mark Putland
  6. Harriet Hiscock
  7. Jonathan Knott
  8. the RMH ED COVID‐19 Working Group

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Abstract

Objective

Early during the coronavirus disease 2019 (COVID‐19) pandemic, Australian EDs experienced an unprecedented surge in patients seeking screening. Understanding what proportion of these patients require testing and who can be safely screened in community‐based models of care is critical for workforce and infrastructure planning across the healthcare system, as well as public messaging campaigns.

Methods

In this cross‐sectional survey, we screened patients presenting to a COVID‐19 screening clinic in a tertiary ED. We assessed the proportion of patients who met testing criteria; self‐reported symptom severity; reasons why they came to the ED for screening and views on community‐based care.

Results

We include findings from 1846 patients. Most patients (55.3%) did not meet contemporaneous criteria for testing and most (57.6%) had mild or no (13.4%) symptoms. The main reason for coming to the ED was being referred by a telephone health service (31.3%) and 136 (7.4%) said they tried to contact their general practitioner but could not get an appointment. Only 47 (2.6%) said they thought the disease was too specialised for their general practitioner to manage.

Conclusions

While capacity building in acute care facilities is an important part of pandemic planning, it is also important that patients not needing hospital level of care can be assessed and treated elsewhere. We have identified a significant proportion of people at this early stage in the pandemic who have sought healthcare at hospital but who might have been assisted in the community had services been available and public health messaging structured to guide them there.

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  1. Version published to 10.1111/1742-6723.13589
  2. ScreenIT

    SciScore for 10.1101/2020.04.15.20067207: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data were stored on REDCap via the hospital’s server in accordance with relevant information security protocols..
    REDCap
    suggested: (REDCap, RRID:SCR_003445)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, our study has some limitations. The survey was conducted in a single ED with only those who had presented to the ED (and not other healthcare providers such as GPs) so our results may not generalise to patient groups beyond our setting. Further, we excluded patients who were assessed at triage to require active medical treatment or resuscitation, which may result in an under-representation of the true number of severe cases presenting to the ED for COVID-19 screening. The survey was based on self-report and we were unable to verify patient responses (e.g. if they had tried to but been unable to get an appointment with a GP). Our data have several clinical and policy implications. Ideally, only patients who require COVID-19 testing based on epidemiological or clinical history should present for screening, with perhaps only those who are unwell presenting to EDs. Given that most patients who presented to our ED had mild symptoms or did not meet screening criteria, serious consideration must be given to re-directing such patients to an alternate service. Failing to do so before patients present to an ED will almost certainly result in EDs becoming overwhelmed, given the anticipated upcoming surge of unwell patients presenting with COVID-19 related respiratory failure. Re-directing well patients or those with only mild illness will require accurate triaging as well as alternative services. Possibilities for alternate services to conduct triaging incorporating epidemiolog...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.04.15.20067207v1 on medRxiv