Screening and Triage at Intake

Screening Dialysis Patients for COVID-19

Key Concepts

To limit the spread of COVID-19, it is important to promptly identify, separate, and put facemasks on those patients who are ill. Screening patients before they enter the facility:

  • Reduces exposures for other patients and healthcare personnel
  • Helps prevent the spread of disease within the facility
  • Helps ensure personal protective equipment (PPE) is used effectively

Screen Patients for COVID-19 at Intake

Facilities should make sure triage procedures are compliant with HIPAA guidance and consider a multi-step screening process to ensure patients with symptoms are not missed prior to entering the treatment area. While the process for screening depends on facility layout and staffing, the general steps include:

  • Advise patients to check their temperature at home before leaving for their dialysis session
  • Instruct patients to notify the facility before arriving if they have fever or respiratory symptoms
    • Consider using automated communications to remind patients about reporting symptoms (e.g., texts on their dialysis day or robocalls)
    • If they have symptoms, they should discuss them with a healthcare provider before arriving
      • Advanced notice gives the facility time to prepare for the patient’s arrival or, if indicated based on symptoms, to refer them to a higher level of care
  • Ask all patients upon entry to the facility if they have a fever, respiratory symptoms including cough or shortness of breath, sore throat, or systemic symptoms like myalgias or chills
    • Place a staff member near all entrances (outdoors if weather and facility layout permit), or in the waiting room area, to ensure patients are screened for symptoms and fever before entering the treatment floor.
  • Send patients to the appropriate waiting areas, which should be organized to divide patients with symptoms from patients without symptoms
    • Separate patients by at least 6 feet, and the area for patients with symptoms should be at least 6 feet away from the area for patients without symptoms
  • Post alerts such as signs and posters at clinic entrances and in strategic places around the facility with instructions for patients with fever or symptoms of respiratory infection

Considerations for Staff

Facilities should make sure staff members who are screening patients remain 6 feet away from the patient until screening determines a patient is symptom-free and afebrile (temperature ascertained by patient report or active temperature monitoring). If there is widespread community transmission of COVID-19, facilities can consider instituting active temperature monitoring by having a staff member check the patient’s temperature immediately upon arrival at the door and when the patient is first asked about symptoms.

  • Screening staff do not need to wear PPE if they are separated from patients by a physical barrier such as a glass or plastic window. Screening staff should make these interactions as brief as possible by limiting the interaction to screening questions only.
  • If a staff member must be within 6 feet of a patient, they should use appropriate PPE, including a facemask, gloves, and eye protection. A gown could be considered if extensive contact with the patients is anticipated.

After a Patient is Screened

If patient reports not having symptoms and no fever is detected (by patient report or on active temperature monitoring if performed), they can be directed to a waiting room area for patients without symptoms. No mask is required.

If patient needs urgent care, immediately notify healthcare provider for further clinical management and to determine if a higher level of care is needed.

If patient reports having symptoms or fever is detected (by patient report or on active temperature monitoring if performed):

  • Provide patient with a facemask, educate them on proper placement of facemask, and instruct them to leave it on while they are in the facility
  • Direct patient to remain 6 feet away from other patients and staff not wearing appropriate PPE Maintain this separation by:
    • Designating a part of the waiting area (taking into account layout and size of waiting area) that is separate from the other patients by at least 6 feet
      OR
    • Designating a separate waiting area in another room for symptomatic patients, if layout permits
      OR
    • Allowing symptomatic patients to wait in a personal vehicle or outside the facility until their treatment time, if medically stable
  • Notify direct patient care staff of the presence of a symptomatic patient
  • Take the patient back to the appropriate treatment area as soon as possible
  • Immediately after departure of the symptomatic patient from waiting area, disinfect surfaces that were within 6 feet of the symptomatic patient
    • Items that cannot be disinfected, such as magazines and other paper materials, should remain with the patient or be discarded
    • This is in addition to the regular (frequent) baseline cleaning and disinfection process that should be occurring for the entire waiting area