ED Usage Tips

(ways to make things easier for your patients when referring them)

 

* Utilize CHOA App for ED/urgent care wait times

* Encourage patients to utilize MyChart to see labs

* If sending patient for a procedure, for ex: abscess drainage, fracture reduction keep them NPO

* ALWAYS call transfer center before referring a patient

* Hughes Spalding is different: no access to surgeons, no ICU, no 24 hour ultrasound, no MRI, minimal subspecialists-Hematology and the O’s (Opthalmology, Non-surgical Orthopedics, Oral Surgery)

* When referring a patient leave a cell phone number to contact you and update your colleagues on patients being referred to the ED

* Labs and X-rays can be done at the hospital as outpatients with an order from you – the patient doesn’t have to come via the ED unless you also want them seen by an ED physician.

* Respiratory viral panel testing is generally not indicated for previously healthy children in whom treatment for influenza is not necessary (or can be done on clinical grounds)

Fever, Viral Symptoms and Testing for Viruses

 

Burgerpic

by Becky Burger, MD

BeckyBurger@emory.edu

As we approach respiratory viral season, we wanted to share our emergency department guideline for performing viral testing via the Respiratory Viral Panel (RVP) test. The RVP is a nasal swab test that detects viruses including influenza, RSV, and several other viruses. The turnaround time for the RVP result is between one and three hours. We have found that these tests sometimes delay disposition and often don’t change management of the patient in the ED. Our quality improvement committee developed the guidance below to optimize RVP testing in the ED.   Please note that we do not perform the new molecular rapid influenza test in the emergency departments at Children’s.

For ED patients being discharged home:

  • RVP usually not indicatedHealthy patients with viral symptoms.   This is because of the following reasons:
  • Prolonged positivity of RVPs from prior illnesses (unrelated to current symptoms)
  • Multiple positives
  • False sense of security
  • Management can usually be based on clinical grounds (e.g. treating influenza in high-flu season)
  • RVP may be done on a case-by-case basisPatients with underlying chronic medical condition, or patients in the age range 4-8 week old with fever etc. where a positive test may change management– in such instances, RVP is helpful only if we wait for result of the test for further decision making such as extent of work up, admission vs. discharge, etc.

For ED patients who require admission:

  • RVP indicatedImmunocompromised patients (such as transplants and certain chronic medical conditions) and other patients at high risk for complications of infection.
  • RVP usually not necessaryImmunocompetent patients (with or without chronic medical problems) – inpatient team may choose to order it themselves if desired.
  • All inpatient rooms at Children’s are private rooms so we don’t need to use RVPs for cohorting purposes.  Also, all respiratory illness patients need appropriate infection control precautions regardless of the result of the RVP.

We do not recommend referral to the emergency department just for RVP testing in well appearing children who have symptoms consistent with viral respiratory infection. For patients with symptoms concerning for influenza who are at higher risk (based on age, severity, or underlying medical conditions), treatment with antiviral medications can be started without the need for lab confirmation of influenza, (particularly during high flu prevalence).

If you have any questions about RVP testing, feel free to contact: Becky Burger, MD, BeckyBurger@emory.edu