An Effective Off-Campus Triage System During the COVID-19 Outbreak

Background: In January 2020, the outbreak of COVID-19 in Wuhan, Hubei spread to Guangdong that became the province with the second largest number of COVID-19 patients in China. Nanhai Hospital, one of the teaching hospitals of Southern Medical University in Guangdong, was designated by the government as one of the hospitals for suspected COVID-19. This presented challenge of how to effectively handle the suspected cases of COVID-19, while avoiding in-hospital cross-infection and maintaining other important services in the hospital. An off-campus triage system has been demonstrated as an effective method to reduce spread of Ebola and other infectious diseases during outbreaks. However, the effectiveness of off-campus triage system for the CCOVID-19 outbreak has not been reported. Methods: We created an off-campus triage system at entry points to the outpatient, emergency, and inpatient departments in the hospital, to triage patients to the appropriate care areas. To support this off-campus triage system, we developed an intensive staff training and evaluation including personal protection measures, a detailed triage procedure and staff scheduling, accurate assessment, and timely referral. Findings: Of the 85,414 patients and visitors to the hospital between January 22 and March 10 of 2020 in Nanhai Hospital, 359 patients were triaged to the COVID-19 fever clinic and 1,218 were triaged to the general fever clinic; 187 were suspected of COVID-19 infection and quarantined; and 4 cases of COVID-19 were confirmed and referred. During the outbreak, no in-hospital infection and no complaint from patients and their family members occurred, and up to March 25, 2020, no new cases of COVID-19 in this hospital or its catchment area were detected. Interpretation: The off-campus triage system is an effective approach to improve detection of COVID-19 infection, reduce in-hospital cross-infection, and improve patient satisfaction. This triage system could be applied in future infectious disease outbreaks. Funding Statement: None. Declaration of Interests: None declared.