A new home-assessment approach to evaluate patients for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may enable safe evaluation and specimen collection outside of healthcare settings, according to results of a study published in Clinical Infectious Diseases.
A home-assessment program was originally developed collaboratively by Harborview Medical Center and Public Health – Seattle & King County (Public Health) in 2014 in response to the potential need to test for Ebola. Currently, with the increased need for real-time clinical assessments of patients with possible coronavirus disease 2019 (COVID-19), the Harborview Home Assessment Team (HAT) was revised.
Patients with symptoms and possible exposure to SARS-CoV-2 are identified by Public Health or through a call to any part of the University of Washington healthcare system; calls were routed to the Infection Prevention & Control Program team responsible for HAT activities. If the patient meets the criteria set by the Centers for Disease Control and Prevention (CDC) for testing, Public Health then determines the appropriateness of a HAT visit.
If deemed necessary, a HAT member first calls the patient for confirmation they are safe to visit, meaning they are breathing comfortably, able to eat and drink, and mobilizing around their home. They also discuss details of the visit, determine locations for donning/doffing, and register the patient in the system to allow for medical record documentation. Every HAT team includes 1 physician, 1 nurse, >1 trained observers dressed in personal protective equipment (PPE), and a site-commander; the team uses 1 or 2 vehicles to transport personnel, PPE, and testing materials.
Upon arrival the physician and nurse enter the home in appropriate CDC-recommended PPE, using standard, contact, and airborne precautions with eye protection. Physicians evaluate the patient, a focused history is gathered, and a physical examination is performed. Specimens for SARS-Cov-2 testing are collected — nasopharyngeal swab, oropharyngeal swab, and sputum, if appropriate. An additional nasopharyngeal swab is also collected for viral respiratory pathogen testing. All equipment used for the assessment are left with the patient, and documents requiring signature are photographed by the patient on their own phone and emailed to a secure email address for uploading into the medical record. Patients are instructed to self-isolate pending the test results and to continue isolation if positive. Public Health also performs a minimum of every-other-day telephone follow-up, more if the patient is medically fragile, until results are obtained and, thereafter, if positive, until symptoms are resolved. Further details regarding donning/doffing and sample collection are available in the original article.
To date, HAT has completed 15 successful community-based visits. The approximate time from dispatch to return is an average of 3 hours. Two patients have tested positive for SARS-CoV-2, though several other patients have tested positive for human coronavirus, rhinovirus, or parainfluenza or had negative results. Patients have reported that the evaluation in this setting is highly acceptable. No instances of contamination of PPE with visible blood or fluids or of breeches of PPE doffing protocol were noted. No HAT members have developed symptoms requiring evaluation.
According to investigators, “the HAT program is a scalable, cost-saving model that cuts-down on resources required to isolate and care for patients.” The model can also be used for other novel outbreaks and in potentially unconventional settings like ships, planes and airports. They added, “the use of home assessment teams in the setting of novel infectious disease epidemics demonstrates the value of integrated and coordinated public health and healthcare systems and corresponding benefits to our patients and the public.”
Bryson-Cahn C, Duchin J, Makarewicz VA, et al. A novel approach for a novel pathogen: using a home assessment team to evaluate patients for 2019 novel coronavirus (SARS-CoV-2) [Published online March 12, 2020]. Clin Infect Dis. doi: 10.1093/cid/ciaa256