GUIDANCE FOR OUTPATIENT PROVIDERS WHEN EVALUATING PATIENTS FOR COVID-19
This guide was created by the New Jersey Division of Consumer Affairs (as of March 22, 2020) to assist outpatient providers evaluate patients for the coronavirus. Health care professionals should still provide ongoing care to patients while being mindful of the critical need to avoid overwhelming the current healthcare system by recommending inappropriate referrals or testing.
General Information on Testing:
There are currently limitations in testing availability. Practitioners should carefully consider patient symptoms and risk factors to determine if testing is appropriate and necessary.
Treatment of Asymptomatic Patients:
Asymptomatic patients should be treated as per usual practice. According to the New Jersey Department of Health, testing is not generally recommended.
Treatment of Symptomatic Patients: Initial Assessment Criteria:
Symptomatic patients with a fever and dry cough should be initially screened through the telephone or other electronic methods. Intake should focus on:
The patient’s risk of exposure to COVID-19. Consideration factors include travel to an area labeled as CDC Level 3 travel advisory and close contact to an individual with COVID-19.
The patient’s age. Consideration factors include if the patient is 65 years or above, and serious underlying illnesses such as diabetes, lung disease and/or cardiac disease.
The severity of the patient’s symptoms.
If the illness will put the public health at greater risk.
Treatment of Symptomatic Patients: Those Determined to be Medically Stable:
- These patients can be advised to stay at home and self-isolate if the risk factors do not result in a compromised physical state.
-Self-isolation should continue for a minimum of 7 days after symptoms have first appeared AND at least 72 hours after the resolution of fever and significant improvements in respiratory symptoms, including the cough.
-If the patient is living with others, it is recommended that they are isolated from others in the house as much as possible.
-Carefully consider the clinical need for testing in these individuals. The New Jersey Department of Health does not recommend testing patients for COVID-19 if they are determined to be medically stable and can be discharged to home. Following this, if others who live with the self-isolating patient develop symptoms, they should follow the same guidelines here as well.
Treatment of Symptomatic Patients: Those NOT Determined to be Medically Stable:
Determining if a patient is medically stable or not would depend on the severity of symptoms and assessment of risk factors. Once determined that a patient requires further assessment, a decision needs to be made whether the patient should be examined in the office setting or sent to another facility. This decision will be based on the availability of Personal Protective Equipment (PPE) in the office.
For offices with adequate PPE and patients who are not medically unstable to the point that higher level of care is necessary:
-Patients should be asked to come at the end of the day to limit contact with other patients. The patient should immediately be asked to put on a mask upon arrival and escorted to a private room. When evaluating the patient, all medical staff should have PPE on. The CDC recommends (1) a gown, (2) gloves, (3) eye/face protection, (4) N95 or better respirators.
For offices WITHOUT adequate PPE and/or patients who are medically unstable to the point that higher level of care is necessary:
-The patient should be referred to the Emergency Department, and you should inform the ED of your referral. Information to include in the referral is all identified risk factors and the physical status of the patient.
-It is crucial to remember that referring patients to the Emergency Department and/or for testing of COVID-19 will place a strain on the currently overwhelmed healthcare system. Thoughtful and careful consideration should take place before the referral.