Jeannie Burnie
Bethesda North Hospital
As the emergency department (ED) clinical nurse specialist, I was asked to guide COVID19 pandemic preparation for a large hospital system in Southwest Ohio with six EDs (critical access, free-standing, urban and suburban) to identify processes involving screening, triage and testing patients. Executive ED leaders worked with the organizations attorney to revise the medical screening exam (MSE) policy. There was concern, with the expected surge, that physicians or advanced practice providers would not be available to provide the MSE. An interdisciplinary team developed standard operating procedures to guide ED nurses in providing the MSE for patients meeting specific, pre-established criteria. Nurses required straight forward tools to document screening, testing if indicated and consistent discharge instructions.
The team determined the need for an alternate care area (ACA) in the ED. Using guidance from the Center for Disease Control, patients presenting with fever, shortness of breath, new onset cough, malaise but stable vital signs would be evaluated in the ACA. A screening process using pulse oximetry to determine saturations above 92% and heart rate below 110 meeting COVID-19 symptoms would be evaluated by a nurse to determine if testing was indicated.