Three Tier Screening Tool and Second Triage to Minimize the Spread of COVID-19 in Emergency Department of a Tertiary Hospital in India

COVID-19, Emergency Service, Hospital, Secondary, Triage


Introduction: Since the outbreak of Coronavirus on December 31, 2019 in Wuhan, Hubei Province, People’s Republic of China, the number of cases from China that have been imported into more than 180 countries and regions around the world. Objective: The goal of this study is to flatten the curve of new infection, through nosocomial transmission by health care system along with early identification of asymptomatic COVID-19 cases. Methods: A Survey was conducted over a period of 35 days. A total of 1709 individuals were screened (647 patients and 1062 patient attendees) coming to emergency Department. The waiting area of Emergency Care was divided into 3 screening zones and a separate second triage is established. The individuals entering are ensured that they are screened at all the 3 zones. Individuals were divided into two Groups after screening: Group A (suspected COVID-19) and Group B (unsuspected COVID-19). In Acute emergencies, the patient was directly treated at second triage. Results: A total of 1709 individuals, 247 in Group A (Suspected COVID-19) and 1462 in Group B (Unsuspected COVID-19). Among 247 individuals, 141 were males and 106 were females. Age ranged from 14-72 years with a mean age of 46.7years. Among 247 individuals (Group A), 81 were patients, of which one case was found to be COVID-19 Positive. Two Health care workers (HCW’s) found to be positive. Conclusion: Challenges from the widespread pandemic underscores the importance of early implementation of a second triage and vigorous screening for all the individuals to minimize the spread of infection, failing which pandemic infection may turn into an epidemic.


Download data is not yet available.


1. World Health Organization. Pneumonia of unknown cause — China. January 5, 2020. [Available from: https://www .who .int/ csr/ don/ 05 –january -2020 –pneumonia–of –unkown –cause -china/en/].
2. World Health Organization. Novel Coronavirus — China. January 12, 2020. [Available from: https://www.who .int/ csr/ don/ 12 –january -2020 –novel –coronavirus -china/ en/].
3. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. . N Engl J Med. 2020;382(8):727-33.
4. Centers for Disease Control and Prevention. Symptoms of coronavirus disease 2019 (COVID-19). 2020. [Availble from:].
5. Jiang S, Shi Z, Shu Y, Song J, Gao GF, Tan W, et al. A distinct name is needed for the new coronavirus. Lancet. 2020 Mar 21;395(10228):949.
6. World Health Organization. Coronavirus disease 2019 (COVID-19): Situational Report-37. February 27, 2020. [Available from: 26-sitrep-37-covid-19.pdf].
7. World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Published January 30, 2020. [Available from: e-outbreak-of-novel-coronavirus-(2019-ncov)].
8. World Health Organization.WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. Published March 11, 2020. [Available from: /who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11- march-2020].
9. Parmet WE, Sinha MS. Covid-19—the law and limits of quarantine. N Engl J Med. 2020;382(15):e28.
10. Klompas M, Morris CA, Sinclair J, Pearson M, Shenoy ES. Universal Masking in Hospitals in the Covid-19 Era. N Engl J Med. 2020; [Epub ahead of print].
11. Chavez S, Long B, Koyfman A, Liang SY. Coronavirus Disease (COVID-19): A primer for emergency physicians. Am J Emerg Med. 2020; [Epub ahead of print].
12. McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG, et al. Epidemiology of covid-19 in a long-term care facility in King County, Washington. N Engl J Med. 2020; [Epub ahead of print].
13. Woodcock A. Coronavirus: fewer than one in 50 NHS frontline staff forced to stay at home have been tested. April 14, 2020. [Available from:].
14. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020;382(10):970-1.
15. Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA. 2020;323(14):1406.
16. Li R, Pei S, Chen B, Song Y, Zhang T, Yang W, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science. 2020;368(6490):489-93.
17. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. N Engl J Med. 2020;382(13):1199.
18. Ministry of Health & Family Welfare, Directorate General of Health Services, (EMR Division). Revised Guidelines on Clinical Management of COVID–19. [Available from: dNationalClinicalManagementGuidelineforCOVID193103.2020.pdf].
19. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020:NEJMoa2002032.
20. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 infection in children. N Engl J Med. 2020; NEJMc2005073.
21. Tagarro A, Epalza C, Santos M, Sanz-Santaeufemia FJ, Otheo E, Moraleda C, et al. Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain. JAMA Pediatr.2020; e201346.
22. Aronson L. Age, Complexity, and Crisis-A Prescription for Progress in Pandemic. N Engl J Med. 2020; [Epub ahead of print].
23. Kwon KT, Ko JH, Shin H, Sung M, Kim JY. Drive-Through Screening Center for COVID-19: a Safe and Efficient Screening System against Massive Community Outbreak. J Korean Med Sci. 2020 Mar 23;35(11):e123.
24. Ranney ML, Griffeth V, Jha AK. Critical Supply Shortages-The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic. N Engl J Med. 2020;382(18):e41.
25. Gostic K, Gomez AC, Mummah RO, Kucharski AJ, Lloyd-Smith JO. Estimated effectiveness of symptom and risk screening to prevent the spread of COVID-19. Elife. 2020;9:e55570.
26. Quilty BJ, Clifford S. Effectiveness of airport screening at detecting travellers infected with novel coronavirus (2019-nCoV). Euro Surveill. 2020;25(5):2000080.
27. Burke RM, Midgley CM, Dratch A, Fenstersheib M, Haupt T, Holshue M, Ghinai I, Jarashow MC, Lo J, McPherson TD, Rudman S. Active Monitoring of Persons Exposed to Patients with Confirmed COVID-19-United States, January-February 2020. MMWR Morb Mortal Wkly Rep. 2020;69(9):245-6.
28. Canelli R, Connor CW, Gonzalez M, Nozari A, Ortega R. Barrier Enclosure during Endotracheal Intubation. N Engl J Med. 2020:NEJMc2007589.
29. Pfefferbaum B, North CS. Mental Health and the Covid-19 Pandemic. N Engl J Med. 2020; [Epub ahead of print].
30. Sehulster L, Chinn RY. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep.2003;52(RR-10):1-42.
How to Cite
Silvery A, Nizami MI, Sharma A, Bhaskar L. Three Tier Screening Tool and Second Triage to Minimize the Spread of COVID-19 in Emergency Department of a Tertiary Hospital in India. Adv J Emerg Med. 4(2s):e50.
Original article