Effectiveness, safety, and efficiency of a drive-through care model as a response to the COVID-19 testing demand in the United States
© 2022 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians..
Objectives: Here we report the clinical performance of COVID-19 curbside screening with triage to a drive-through care pathway versus main emergency department (ED) care for ambulatory COVID-19 testing during a pandemic. Patients were evaluated from cars to prevent the demand for testing from spreading COVID-19 within the hospital.
Methods: We examined the effectiveness of curbside screening to identify patients who would be tested during evaluation, patient flow from screening to care team evaluation and testing, and safety of drive-through care as 7-day ED revisits and 14-day hospital admissions. We also compared main ED efficiency versus drive-through care using ED length of stay (EDLOS). Standardized mean differences (SMD) >0.20 identify statistical significance.
Results: Of 5931 ED patients seen, 2788 (47.0%) were walk-in patients. Of these patients, 1111 (39.8%) screened positive for potential COVID symptoms, of whom 708 (63.7%) were triaged to drive-through care (with 96.3% tested), and 403 (36.3%) triaged to the main ED (with 90.5% tested). The 1677 (60.2%) patients who screened negative were seen in the main ED, with 440 (26.2%) tested. Curbside screening sensitivity and specificity for predicting who ultimately received testing were 70.3% and 94.5%. Compared to the main ED, drive-through patients had fewer 7-day ED revisits (3.8% vs 12.5%, SMD = 0.321), fewer 14-day hospital readmissions (4.5% vs 15.6%, SMD = 0.37), and shorter EDLOS (0.56 vs 5.12 hours, SMD = 1.48).
Conclusion: Curbside screening had high sensitivity, permitting early respiratory isolation precautions for most patients tested. Low ED revisit, hospital readmissions, and EDLOS suggest drive-through care, with appropriate screening, is safe and efficient for future respiratory illness pandemics.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:3 |
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| Enthalten in: |
Journal of the American College of Emergency Physicians open - 3(2022), 6 vom: 15. Dez., Seite e12867 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ravi, Shashank [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Revised 03.01.2023 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1002/emp2.12867 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM350818738 |
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| 100 | 1 | |a Ravi, Shashank |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Effectiveness, safety, and efficiency of a drive-through care model as a response to the COVID-19 testing demand in the United States |
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| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2022 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians. | ||
| 520 | |a Objectives: Here we report the clinical performance of COVID-19 curbside screening with triage to a drive-through care pathway versus main emergency department (ED) care for ambulatory COVID-19 testing during a pandemic. Patients were evaluated from cars to prevent the demand for testing from spreading COVID-19 within the hospital | ||
| 520 | |a Methods: We examined the effectiveness of curbside screening to identify patients who would be tested during evaluation, patient flow from screening to care team evaluation and testing, and safety of drive-through care as 7-day ED revisits and 14-day hospital admissions. We also compared main ED efficiency versus drive-through care using ED length of stay (EDLOS). Standardized mean differences (SMD) >0.20 identify statistical significance | ||
| 520 | |a Results: Of 5931 ED patients seen, 2788 (47.0%) were walk-in patients. Of these patients, 1111 (39.8%) screened positive for potential COVID symptoms, of whom 708 (63.7%) were triaged to drive-through care (with 96.3% tested), and 403 (36.3%) triaged to the main ED (with 90.5% tested). The 1677 (60.2%) patients who screened negative were seen in the main ED, with 440 (26.2%) tested. Curbside screening sensitivity and specificity for predicting who ultimately received testing were 70.3% and 94.5%. Compared to the main ED, drive-through patients had fewer 7-day ED revisits (3.8% vs 12.5%, SMD = 0.321), fewer 14-day hospital readmissions (4.5% vs 15.6%, SMD = 0.37), and shorter EDLOS (0.56 vs 5.12 hours, SMD = 1.48) | ||
| 520 | |a Conclusion: Curbside screening had high sensitivity, permitting early respiratory isolation precautions for most patients tested. Low ED revisit, hospital readmissions, and EDLOS suggest drive-through care, with appropriate screening, is safe and efficient for future respiratory illness pandemics | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Graber-Naidich, Anna |e verfasserin |4 aut | |
| 700 | 1 | |a Sebok-Syer, Stefanie S |e verfasserin |4 aut | |
| 700 | 1 | |a Brown, Ian |e verfasserin |4 aut | |
| 700 | 1 | |a Callagy, Patrice |e verfasserin |4 aut | |
| 700 | 1 | |a Stuart, Karen |e verfasserin |4 aut | |
| 700 | 1 | |a Ribeira, Ryan |e verfasserin |4 aut | |
| 700 | 1 | |a Gharahbaghian, Laleh |e verfasserin |4 aut | |
| 700 | 1 | |a Shen, Sam |e verfasserin |4 aut | |
| 700 | 1 | |a Sundaram, Vandana |e verfasserin |4 aut | |
| 700 | 1 | |a Yiadom, Maame Yaa A B |e verfasserin |4 aut | |
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