3. SCREENING OF SARS CASES OR SUSPECT

To facilitate early identification of patients who may be SARS Suspects, screening will be conducted at the Triage Area outside the Emergency Room and the Outpatient department.

3.1. Pre-Screening

· Before patients enter the main Emergency Room the security guard asks the patients the following questions:

“ Does the patient have fever, cough or shortness of breath? ”

• Patients without fever and or respiratory symptoms are directed to the main Emergency Room for management of other problems while those with fever and or respiratory symptoms are requested to pass the triage area for further questioning.

• All patients including MDH employees and staff with fever and respiratory sign and symptoms.

Physical Requirements of the Triage and SARS Holding Area

• The triage and holding area is completely separated from Emergency room by a transparent wall to prevent exposure of patients and health care workers to infectious diseases. It is provided with a separate ventilation system to attain a negative pressure and an intercom system connecting the triage with the main ER. Personnel assigned to the triage must be trained on how to screen patients and apply proper infection control precautions. He must wear an N95 mask.

3.2. Screening

• Patients with history of cough and fever are directed to the triage asked to lift the intercom phone to answer questions.

• The intern assigned in the triage who stays inside the main ER administers the screening questionnaire (see attached). The questionnaire also serves as the patients case report form. It contains the patient demographic data, address and contact numbers, the targeted questions, assessment of SARS status and final disposition of the patient.

• Screening may also be conducted inside the OPD and Doctor’s Clinic. At the triage, the intern ask patients for signs and symptoms that may be suggestive of or consistent with SARS.

• The Infection Control Nurse collects this form at the end of each day and submit weekly report of all cases to SARS Taskforce.

MANILA DOCTORS HOSPITAL

SARS SCREENING FORM

Patient No. ______________________

Date of Consult: ______________

MM/DD/YYYY

Name of Patient: ______________________________________________ Age/Sex: ______ Occupation: ______________

Last Name First Name MI

Address: ___________________________________________________ Tel. No.: ________________/__________________ ____________________________________________________ (Residence) (Office) ____________________________________________________ Cell Phone No. __________________________

Accompanied by: ___________________________________________ Relation to Patient ________________________

Address: ______________________________________________ Tel.No._______________/__________________ ___________________________________________________ (Residence) (Office)

___________________________________________________ Cell Phone No.: ______________________________

_____________________________________________________________________________________________________________

1. At ENTRY (OPD, Doctors Clinic, ER Entrance)

Do you have any of the following? ______Yes _______No

____ Fever ____ Cough ____ Colds ____ Shortness of Breath ____ Difficulty of breathing

2. TRIAGE (OPD, Doctors’ Clinic, ER Entrance)

2.1 Travel History

Did you travel in the following countries with in 14 days from the onset of respiratory signs and symptoms? When and Where?

When? (date) . When? (date)

_______ China _____________ ______ Hanoi, Vietnam ______________

______ Hongkong _____________ ______ Toronto, Canada ______________

______ Guangdong _____________ ______ Singapore ______________

______ Taiwan _____________ ______ Others Specify ______________

When did you arrive in the Philippines? __________________

(MM/DD/YYYY)

2.2. EXPOSURE HISTORY

2.2.1. Have you had close contact or exposure with any house hold member with respiratory

illness who traveled to the above mentioned places? ______ Yes _______No

2.2.2. Have you had close contact or exposure with a friend or business partner with respiratory

illness who traveled to the above mentioned places? ______ Yes _______ No

2.2.3. Have you taken cared of or have direct contact with diagnosed case or suspect of SARS? __Yes __ No

2.3. ASSESSMENT 2.4. DISPOSITION

_______ Non SARS ________ To ER or OPD

_______ Asymptomatic SARS ________ Home w/ advise

_______ Undetermined (w/ one symptom) ________ Transferred to RITM/San Lazaro

_______ Suspect SARS ________ Transferred to RITM/San Lazaro

_______________________

Signature Over Printed Name

MANILA DOCTORS HOSPITAL FLOW CHART FOR THE EVALUATION OF PATIENT WITH SARS

Yes

yes yes

No

Yes Yes

SARS SUSPECT CASE

1. Inform patient about result of assessment and hospital

policy on admission of SARS referral and transfer to SARS hospital.

2. Provide surgical mask to patient & isolate to Holding Area

Coordinate transfer to RITM or San Lazaro

Hospital

3. Implement proper infection control precautions for

emergency transport of patients & management of exposures in HCW.

4. Inform NEC
5. Transfer to RITM or San Lazaro Hospital

Yes Yes