BLDE University Journal of Health Sciences

LETTER TO EDITOR
Year
: 2021  |  Volume : 6  |  Issue : 1  |  Page : 106--108

A three-point triage system to enhance hospital preparedness during the COVID-19 pandemic


Varun Suresh 
 Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India

Correspondence Address:
Dr. Varun Suresh
Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala
India




How to cite this article:
Suresh V. A three-point triage system to enhance hospital preparedness during the COVID-19 pandemic.BLDE Univ J Health Sci 2021;6:106-108


How to cite this URL:
Suresh V. A three-point triage system to enhance hospital preparedness during the COVID-19 pandemic. BLDE Univ J Health Sci [serial online] 2021 [cited 2021 Jul 26 ];6:106-108
Available from: https://www.bldeujournalhs.in/text.asp?2021/6/1/106/313355


Full Text



Sir,

The COVID-19 pandemic has crossed all national boundaries. It has affected almost all the nations of the world, paralyzed their social life limiting human movements, and shattered economies.[1] There has been a mass emergency response and hospital preparedness reactions across India to mitigate the spread of the disease. Anesthesiologists form an integral part of the emergency response and intensive care COVID-19 teams everywhere. An anesthesiologist as an intensive care physician will be required to assess the ventilation and oxygenation requirement of the patient along with monitoring hemodynamics and selecting appropriate therapy. India appears to be already in the third stage of this pandemic (indigenous cases amounting to community spread). Hence, their contribution to emergency preparedness has far-reaching implications to mitigate the chain of disease spread.

A well-planned triage system can prevent secondary transmission of diseases during pandemics.[2],[3] A modified triage system called “three-point triage” was implemented in our outpatient and preanesthesia checkup clinics in the wake of the COVID-19 pandemic, on the direction of public health authorities.[4] COVID-19 cases are classified as “laboratory-confirmed case;” “suspect case;” and “contacts” (high risk and low risk, further sub-classified as asymptomatic and symptomatic). The aim was to identify suspect cases and high-risk contacts for “isolating” them as early as possible to prevent secondary transmission.

This first triage point is the already-existent triage in the emergency/casualty departments. A mandatory screening questionnaire [Figure 1] was introduced on to the outpatient records and preanesthesia record of every patient, which seeks information about risk factors for COVID-19. Signages were also set up at possible points of patient crowding directing availability of fever clinics. Patients with concordant entry to any of the screening questions were directed to attend the triage point-2 setup near the fever isolation facility of the hospital where further clinical assessment was done. On this assessment, if the patient was found asymptomatic, he/she was reassured, re-assessed for emergency/elective nature of present visit to hospital, and further kept on home follow-up for 28 days by the community health-care system, through designated health officers. If the patient was found to be symptomatic and diagnosis could be explained by other causes, he/she was treated as per standard treatment guidelines of the concerned department.{Figure 1}

If a patient was found to be symptomatic but diagnosis cannot be explained by other causes, he/she was re-located to triage point-3 at the isolation facility of the hospital. Patients reaching triage point-3 [Figure 1] were screened and evaluated as per the existing COVID-19 guidelines and admitted to hospital under the isolation facility. Further demographic data and clinical data were collected by doctors and health-care workers donned in personnel protective equipment. It was also ensured that patients requiring screening were carefully directed to triage point-3 ensuring no contact happens with any other person during the transfer.

Stochastic mathematical models[5] have projected that if unchecked, India will have approximate 3 million cases (2,979,928 ± 332,369), with 125,455 (±18,034) requiring hospitalizations, 26,130 (±3298) intensive care unit admissions, and 13,447 (±1819) deaths. This can completely overwhelm the Indian health-care system. This points to the merits of adoption of triaging as an overwhelmingly imperative system, along with home and institutional quarantine, contact tracing, isolation, social distancing, and hand hygiene. We hope that our experience with implementing the three-point triage shall serve as guidance to future efforts on breaking the chain of disease spread.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Novel Coronavirus (2019-nCoV) situation reports; 2020. Available from: https://www. who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. [Last accessed on 2020 Jun 05].
2Zhang J, Zhou L, Yang Y, Peng W, Wang W, Chen X. Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics. Lancet Respir Med 2020;8:e11-2.
3Ayebare RR, Flick R, Okware S, Bodo B, Lamorde M. Adoption of COVID-19 triage strategies for low-income settings. Lancet Respir Med 2020;8:e22.
4National Health Mission Kerala. Available from: http://www.arogyakeralam.gov.in/index.php/corona/corona-guidelines. [Last accessed on 2020 Jun 05].
5Chatterjee K, Chatterjee K, Kumar A, Shankar S. Healthcare impact of COVID-19 epidemic in India: A stochastic mathematical model. Med J Armed Forces India 2020;76:147-55.