J Korean Med Sci.  2021 Nov;36(42):e295. 10.3346/jkms.2021.36.e295.

Analysis of a COVID-19 Prescreening Process in an Outpatient Clinic at a University Hospital during the COVID-19 Pandemic

• Choi UY
• Jung SE
• Kim MS
• Oh HS
• Kwon YM
• Lee J
• Choi JH

• KMID: 2522117
• DOI: http://doi.org/10.3346/jkms.2021.36.e295

Abstract

Background
To minimize nosocomial infection against coronavirus disease 2019 (COVID-19), most hospitals conduct a prescreening process to evaluate the patient or guardian of any symptoms suggestive of COVID-19 or exposure to a COVID-19 patient at entrances of hospital buildings. In our hospital, we have implemented a two-level prescreening process in the outpatient clinic: an initial prescreening process at the entrance of the outpatient clinic (PPEO) and a second prescreening process is repeated in each department. If any symptoms or epidemiological history are identified at the second level, an emergency code is announced through the hospital's address system. The patient is then guided outside through a designated aisle. In this study, we analyze the cases missed in the PPEO that caused the emergency code to be applied.
Methods
All cases reported from March 2020 to April 2021 were analyzed retrospectively. We calculated the incidence of cases missed by the PPEO per 1,000 outpatients and compared the incidence between first-time hospital visitors and those visiting for the second time or more; morning and afternoon office hours; and days of the week.
Results
During the study period, the emergency code was applied to 449 cases missed by the PPEO. Among those cases, 20.7% were reported in otorhinolaryngology, followed by 11.6% in gastroenterology, 5.8% in urology, and 5.8% in dermatology. Fever was the most common symptom (59.9%), followed by cough (19.8%). The incidence of cases per 1,000 outpatients was significantly higher among first-time visitors than among those visiting for the second time or more (1.77 [confidence interval (CI), 1.44–2.10] vs. 0.59 [CI, 0.52–0.65], respectively) (P < 0.001).
Conclusion
Fever was the most common symptom missed by the PPEO, and otorhinolaryngology and gastroenterology most frequently reported missed cases. Cases missed by the PPEO were more likely to occur among first-time visitors than returning visitors. The results obtained from this study can provide insights or recommendations to other healthcare facilities in operating prescreening processes during the COVID-19 pandemic.

Keyword

COVID-19; Outpatient Clinic; Prescreening; Missed Cases

Figure

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  Fig. 1 Two-level prescreening process in the outpatient clinic to detect patients and accompanying guardians with suspected COVID-19. Criteria: temperature ≥ 37.5°C or ≥ 38°C (the cutoff temperature was decided according to the number of newly confirmed COVID-19 cases in Korea).COVID-19 = coronavirus disease 2019, OSC = outside screening center.

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  Fig. 2 The incidence of cases missed in the prescreening PPEO was calculated per 1,000 outpatients. (A) Comparison between first-time visitors and returning visitors. (B) Comparison between those visiting in the morning and those visiting in the afternoon. (C) Comparison between the days of the week.PPEO = prescreening process at the entrance of the outpatient clinic.

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