TESTS/ADMISSION

Currently our Testing Criteria is all patients being hospitalized, regardless of symptoms. In addition, if an inpatient develops new infectious symptoms, requires escalation of care, or has a visitor who has suspected of confirmed COVID-19 they will be tested.

Our current testing recommendations can be found hereDownload
Current Testing and Placement Guidelines (UPDATED 1/19/21)Download
Oncology Patient Placement Guidelines (UPDATED 1/19/21)Download
  • PATIENT PLACEMENT (updated 11/27)
    • Patients being admitted from the ER
      • All patients will have 15 minute test completed in ER along with 90 minute test
        • Patient placement should be based on diagnosis and 15 minute test results
          • If the presumptive test is negative and the patient is asymptomatic, patients can be placed in a neutral room
          • If the rapid 15 minute test is positive, patients should be placed in a NEGATIVE pressure room with Heightened Isolation Precautions
          • All W4 room are now negative pressure isolation
    • Direct admits: ie transports or clinic admissions
      • Asymptomatic: 15 minute test with 90 minute confirmatory test. Patients should be placed in a neutral room
      • Symptomatic (HFNC, BIPAP, Vent, Trach Vent, Continuous Nebs, Q2 respiratory treatments)
        • Patients should go to appropriate unit in a NEGATIVE pressure room with Heightened Isolation Precautions
        • Patients will have a 15 minute and 90 minute test completed
          • If presumptive negative from 15 minute test, may move to standard isolation precautions per patient care needs
          • Patient may move out of negative pressure room after 90 minute test confirmation
          • If positive, patient will remain in negative pressure room
    • Oncology Patients
      • Will undergo a 15 minute and 90 minute confirmatory test
      • Placement should be on W5 and negative pressure rooms if symptoms deem appropriate and again follow steps listed above in blue for testing movement
      • IF the patient is already hospitalized on the HOT unit and moving to the ICU due to new onset of symptoms they should be placed in a NEGATIVE pressure room until their testing comes back
      • Patients that are Critically Immunocompromised Patients will only require one negative 90 minute test.
    • Trauma Patients
      • If history is unknown should be placed in NEGATIVE pressure room and will remain in heightened isolation precautions until 90 minute confirmatory test is negative.

So to summarize, patients no longer need to be admitted to Special Isolation Units. Placement will be based on their symptoms and presentation and guided by results of the 15 minute test.

NEGATIVE pressure rooms should be utilized for: known COVID positive patients, Symptomatic Patients awaiting test results, patients with unknown status ie unable to test or refuse testing, and patients that are symptomatic with CONFIRMED DIRECT primary exposure.

 Patient Type Patient Placement Repeat Testing Isolation Criteria to move out of HIP isolation Notes 
Symptomatic CIP Placed in negative pressure room until 90 min (PCR)  confirmatory test resulted None HIP Negative test result from 90 minute (PCR) confirmatory test 
Asymptomatic CIP CIP patient placement None Immunocompromised N/A 
Symptomatic SOT WITHOUT CIP label Placed in negative pressure room until 90 min confirmatory test resulted None HIP Negative test result from 90 minute (PCR) confirmatory test CIP status to be discussed on acceptance of admission, if  there is provider desire to treat as CIP due to change in patient  status, Admitting team to page  IP to add CIP alert 
New patient admission requiring respiratory interventions*(see below for criteria), with no known exposure Placed in negative pressure room until 90 min (PCR)  confirmatory test resulted None HIP Negative test result from 90 minute (PCR) confirmatory test Continue to use normal isolation practices based on symptoms present after COVID test  resulted 
Admitted patient needing new respiratory interventions* requiring transfer to ICU If emergent transfer prior to test result, place in negative pressure room until 90 min (PCR) confirmatory test resulted None HIP Negative test result from 90 minute (PCR) confirmatory test Continue to use normal isolation practices based on symptoms present after COVID test  resulted 
Admitted patient requiring increased respiratory interventions*NOT needing  transfer to ICU Stay on current unit None Contact Droplet N/A Move to negative pressure on current unit if testing positive for COVID. Continue to use  normal isolation practices based on symptoms present after COVID test resulted 
Patient requiring respiratory interventions*  AND  CONFIRMED exposure within the last  2 weeks Placed in negative pressure room 72 hours after initial test HIP Stay until result of  72 hour test At 72 hours, order 90 minute (PCR) test. Parents should stay in room with patient for duration of visit, limit movement in the hospital. Once 72 hour test is resulted, if negative, place in a NEUTRAL pressure room 
Asymptomatic patient  OR  Patient without need for respiratory interventions* AND CONFIRMED direct PRIMARY** exposure within the last  2 weeks Placed in neutral pressure room until 90 minute (PCR) test result 72 hours after  initial test Continue to use normal isolation  practices based on symptoms present N/A At 72 hours, order 90 minute (PCR) test. Parents should stay in room with patient for duration of visit, limit movement in the hospital 
Patient transfer with COVID test completed at  OSH, or direct admits placement Placed in negative pressure room if respiratory interventions* until 90 min (PCR) test resulted; all others placed in neutral pressure until 90 min (PCR) test resulted Repeat testing at  CHW HIP isolation if respiratory interventions*, or normal isolation practices based on symptoms present. Negative test completed at CHW 
Pre procedure or repeat OR/sedation Normal placement Repeat procedures  will accept a test  within 72 hours if no other  circumstances have changed. Continue to use normal isolation  practices based on symptoms present N/A 
Confirmed or suspected MIS-C patient Negative pressure until 90 minute test resulted None HIP Negative 90 minute test Pending COVID IgG does not require any specific isolation. 
Updated 10/1

*Respiratory Symptoms with the Following Interventions:  Acute Care: defined as HFNC ≤8LPM, IPV Respiratory Treatments, Continuous Nebs, Q2 ; Critical Care: defined as Respiratory Failure (HFNC, BIPAP, CPAP,Trach Vent, IPV Respiratory Treatments, Continuous Nebs) Testing: 15 minute Abbott Test along with the 90 minute test 
** Primary direct exposure: direct contact with a caregiver with confirmed COVID ; Indirect exposure: A patient that was exposed to a caregiver that was exposed 

*** May discontinue isolation when at less than 20 days when the illness is mild to moderate and the patient is not severely immunocompromised AND a provider confirms:  At least 10 days have passed since symptoms first appeared, At least 24 hours have passed since last fever without the use of fever-reducing medications and symptoms have improved; Asymptomatic patients who are COVID + must stay in isolation for 10 days since the date of the positive COVID test 

MIS-C order set looks like the following. Please be sure to order a Covid IgG PRIOR to the patient receiving IVIG for treatment.

EPIC HAS MANY USER-FRIENDLY RESOURCES AVAILABLE FOR COVID-19 INCLUDING ORDER SETS, PATIENTS LISTS, AND DISCHARGE INFORMATION. CLICK HERE FOR MORE DETAILS.

Trauma Screening

  • The trauma activated patient will remain in COVID-19 precautions until a verbal screen can be completed or a swab is resulted.
  • All trauma patients should have the standard screening questions completed before entering the EDTC/hospital when possible. However, if unable to do so, the screening questions should be asked as part of the secondary survey.
  • All attempts should be made to have the screen completed before the patient leaves the EDTC in order to minimize PPE consumption elsewhere in the hospital even if this means keeping the patient in the EDTC for a reasonable length of time. A discussion should be held between both the ED Charge Attending and the Surgical Attending to discuss this length of time.
  • Patients going to the OR either emergently or in delayed fashion will be tested for COVID-19. However, if the standard screening questions are negative they should not be considered a Patient Under Investigation (PUI) and do not need to be admitted to the Special Infection Unit (SIU) or be in isolation in the PICU. When possible the procedure should be delayed until the results return.
  • If the patient is COVID tested positive or the cases involve dental or airway procedures, OR 5 will be utilized. All other patients, including those without a clear COVID status, will be in the regular trauma OR.