Michels Collin, Hekman Daniel J, Schwei Rebecca J, Tsuchida Ryan E, Gauger Joshua, Hurst Irene, Glazer Joshua, Brink Jenna, Barclay-Buchanan Ciara, Shah Manish N, Hamedani Azita G, Pulia Michael
University of Wisconsin-Madison School of Medicine and Public Health, BerbeeWalsh, Department of Emergency Medicine, Madison, Wisconsin.
University of Wisconsin-Madison, College of Engineering, Industrial and Systems Engineering, Madison, Wisconsin.
West J Emerg Med. 2025 May 2;26(3):507-512. doi: 10.5811/westjem.34850.
During the COVID-19 pandemic, rapid, at-home testing for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) was inconsistently available. Consequently, for some patients, emergency departments (ED) became the preferred site to access COVID-19 testing. To improve operational efficiency, our ED implemented a "COVID-19 Test" chief concern (CC). Our primary objective in this analysis was to broadly assess the utilization of the new "COVID-19 Test" CC and associated clinical care.
We conducted a retrospective analysis of ED encounters from an academic ED and an affiliated, community-based ED of all patients after the establishment of a CC of "COVID-19 Test" from October 11, 2021-July 31, 2022. The data were extracted from the electronic health record. We calculated descriptive demographic statistics and ran a univariate and multivariate logistic regression with additional diagnostic or therapeutic interventions (binary) as the outcome variable to generate odds ratios (OR) and 95% confidence intervals (CI).
A total of 320 patients were assigned a "COVID-19 Test" CC by a triage nurse. This was 0.5% of all ED encounters in this time frame. Of those, 45% were found to be SARS-CoV-2 positive. Admission or repeat ED visit at 72 hours occurred in 5.3% of patients. Nearly half (46.9%) of patients assigned a "COVID-19 Test" CC underwent additional ED interventions. Patients on Medicaid and those who self-identified as Black or Hispanic/Latino were disproportionately represented in the "COVID-19 Test" CC group as compared to the overall ED population. In multivariate analysis, an Emergency Severity Index of 1, 2 or 3 was associated with significantly higher odds of receiving additional interventions compared to ESI of 4 or 5 (adjusted OR: 46.85; 95% CI 13.28-165.26; P <0.001).
Patients assigned a chief concern of "COVID-19 Test" had a high COVID-19 positivity rate, often underwent additional ED interventions, and were at low risk of return ED visits or admission. Minoritized and low-income patients were disproportionately represented in the "COVID-19 Test" CC group, highlighting potential disparities in access to at-home COVID-19 testing and implementation of this CC.
在新冠疫情期间，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的快速居家检测供应不稳定。因此，对于一些患者来说，急诊科（ED）成为了进行新冠病毒检测的首选地点。为了提高运营效率，我们的急诊科实施了一项“新冠病毒检测”主要诉求（CC）。我们此次分析的主要目的是广泛评估新的“新冠病毒检测”主要诉求的使用情况及相关临床护理情况。
我们对一家学术性急诊科及其附属的社区急诊科在2021年10月11日至2022年7月31日设立“新冠病毒检测”主要诉求后所有患者的急诊就诊情况进行了回顾性分析。数据从电子健康记录中提取。我们计算了描述性人口统计学统计数据，并以额外的诊断或治疗干预措施（二元变量）作为结果变量进行单变量和多变量逻辑回归分析，以生成比值比（OR）和95%置信区间（CI）。
共有320名患者被分诊护士分配了“新冠病毒检测”主要诉求。这占该时间段内所有急诊就诊患者的0.5%。其中，45%的患者新冠病毒检测呈阳性。5.3%的患者在72小时内入院或再次前往急诊科就诊。被分配“新冠病毒检测”主要诉求的患者中，近一半（46.9%）接受了额外的急诊科干预措施。与整个急诊科患者群体相比，医疗补助计划参保患者以及自我认定为黑人或西班牙裔/拉丁裔的患者在“新冠病毒检测”主要诉求组中的占比过高。在多变量分析中，与急诊严重程度指数（ESI）为4或5相比，ESI为1、2或3的患者接受额外干预措施的几率显著更高（调整后的OR：46.85；95%CI 13.28 - 165.26；P<0.001）。
被分配“新冠病毒检测”主要诉求的患者新冠病毒阳性率较高，经常接受额外的急诊科干预措施，且再次前往急诊科就诊或入院的风险较低。少数族裔和低收入患者在“新冠病毒检测”主要诉求组中的占比过高,这凸显了在获取新冠病毒居家检测以及实施该主要诉求方面可能存在的差异。
