Evolution of an Emergency Department Screening Questionnaire for Severe Acute Respiratory Syndrome

Objectives: To describe the screening tool that was used to screen for severe acute respiratory syndrome (SARS), the three revisions that were made, and the factors that led to these revisions. On March 13, 2003, on receiving notification of an outbreak of atypical pneumonia, nurses from the study emergency department (ED) started screening patients for the disease that became known as SARS. Methods: The ED nurses started with a simple screening tool that was incorporated into triage. The screening tool was later revised into a questionnaire. An outdoor screening station was set up and patients were subsequently screened before triage. After the patients were screened, they were assigned to different risk areas, where triage and treatment were rendered. Two further revisions were made to the questionnaire. Results: From March 13 to May 31, 11,457 patients were screened. Version One of the screening questionnaire was used to screen 72 patients from March 13 to 17, Version Two screened 93 patients from March 18 to 21, Version Three screened 2,909 patients from March 22 to April 8, and Version Four screened 8,383 patients from April 9 to May 31. There was a significant (p < 0.05) downward trend in the proportion of admissions. Among those discharged from the ED, 0.28% reattended and were later confirmed to have SARS. Conclusions: The screening tool underwent three major revisions in response to new information. By keeping it relatively simple, user-friendly, and regularly updated, nurses were able to screen patients rapidly. Risk categorization ensured that no cross-infection occurred among patients and that no one contracted SARS in the ED.