The Utility of Preliminary Patient Evaluation in a Febrile Respiratory Infectious Disease Unit outside the Emergency Department

Kang, Jun Sik; Jhun, Byung Woo; Yoon, Hee; Lim, Seong Mi; Ko, Eunsil; Park, Joo Hyun; Hwang, Sung Yeon; Lee, Se Uk; Lee, Tae Rim; Cha, Won Chul; Shin, Tae Gun; Sim, Min Seob; Jo, Ik Joon

All emergency center patients were triaged in the FRIDU triage room outside the ED. After that, patients who had any of the following conditions were screened for contagious diseases in the FRIDU before entering the ED or being admitted to the hospital: 1) fever ≥ 37.5°C (99.5°F) and respiratory symptoms including cough, sputum, or dyspnea (modified Medical Research Council ≥ II), 2) history of travel to high-risk countries within 2-4 weeks, regardless of fever or respiratory symptoms (e.g., Middle East for MERS-CoV or West Africa for Ebola) by the Centers for Disease Control and Prevention guidance, or 3) signs and symptoms suggesting airborne disease, such as chickenpox or tuberculosis. When a patient was determined to be clinically deteriorated at the FRIDU, the patient was moved to the resuscitation zone equipped with a portable negative pressure ventilation system or isolated in a single room with a door in the ED. After FRIDU screening, patients were categorized according to the following three isolation levels based on the attending ED physician's diagnosis: 1) suspected of having a contagious disease requiring isolation (e.g., patients with influenza or pulmonary tuberculosis), 2) immunocompromised status requiring reverse isolation (e.g., patients with neutropenia), or 3) not requiring isolation (e.g., patients with a urinary tract infection). After the initial diagnostic work up, some patients requiring hospitalization were directly admitted from the FRIDU without entering the ED; some were hospitalized or discharged after entering the ED and receiving additional medical examinations; and some were discharged, referred elsewhere, or followed by the outpatient clinic without entering the ED or being hospitalized.