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{
    "pk": 34850,
    "title": "Evaluating the Implementation of a “COVID-19 Test” Chief Concern in the Emergency Department",
    "subtitle": null,
    "abstract": "<p><strong>Background:</strong> 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. </p>\n<p><strong>Methods:</strong> 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). </p>\n<p><strong>Results:</strong> 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 &lt;0.001). </p>\n<p><strong>Conclusion:</strong> 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.</p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "COVID-19"
        },
        {
            "word": "chief complaint"
        },
        {
            "word": "Chief Concern"
        },
        {
            "word": "triage"
        }
    ],
    "section": "Emergency Department Operations",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/6fn127r2",
    "frozenauthors": [
        {
            "first_name": "Collin",
            "middle_name": "",
            "last_name": "Michels",
            "name_suffix": "",
            "institution": "University of Wisconsin–Madison School of Medicine and Public Health, BerbeeWalsh, Department of Emergency Medicine, Madison, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Daniel",
            "middle_name": "J.",
            "last_name": "Hekman",
            "name_suffix": "",
            "institution": "University of Wisconsin–Madison School of Medicine and Public Health, BerbeeWalsh, Department of Emergency Medicine, Madison, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Rebecca",
            "middle_name": "J.",
            "last_name": "Schwei",
            "name_suffix": "",
            "institution": "University of Wisconsin–Madison School of Medicine and Public Health, BerbeeWalsh, Department of Emergency Medicine, Madison, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Ryan",
            "middle_name": "E.",
            "last_name": "Tsuchida",
            "name_suffix": "",
            "institution": "University of Wisconsin–Madison School of Medicine and Public Health, BerbeeWalsh, Department of Emergency Medicine, Madison, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Joshua",
            "middle_name": "",
            "last_name": "Gauger",
            "name_suffix": "",
            "institution": "University of Wisconsin–Madison School of Medicine and Public Health, BerbeeWalsh, Department of Emergency Medicine, Madison, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Irene",
            "middle_name": "",
            "last_name": "Hurst",
            "name_suffix": "",
            "institution": "University of Wisconsin–Madison School of Medicine and Public Health, BerbeeWalsh, Department of Emergency Medicine, Madison, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Joshua",
            "middle_name": "",
            "last_name": "Glazer",
            "name_suffix": "",
            "institution": "University of Wisconsin–Madison School of Medicine and Public Health, BerbeeWalsh, Department of Emergency Medicine, Madison, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Jenna",
            "middle_name": "",
            "last_name": "Brink",
            "name_suffix": "",
            "institution": "University of Wisconsin–Madison School of Medicine and Public Health, BerbeeWalsh, Department of Emergency Medicine, Madison, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Ciara",
            "middle_name": "",
            "last_name": "Barclay-Buchanan",
            "name_suffix": "",
            "institution": "University of Wisconsin–Madison School of Medicine and Public Health, BerbeeWalsh, Department of Emergency Medicine, Madison, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Manish",
            "middle_name": "N.",
            "last_name": "Shah",
            "name_suffix": "",
            "institution": "University of Wisconsin–Madison School of Medicine and Public Health, BerbeeWalsh, Department of Emergency Medicine, Madison, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Azita",
            "middle_name": "G.",
            "last_name": "Hamedani",
            "name_suffix": "",
            "institution": "University of Wisconsin–Madison School of Medicine and Public Health, BerbeeWalsh, Department of Emergency Medicine, Madison, Wisconsin",
            "department": ""
        },
        {
            "first_name": "Michael",
            "middle_name": "",
            "last_name": "Pulia",
            "name_suffix": "",
            "institution": "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",
            "department": ""
        }
    ],
    "date_submitted": "2024-08-22T15:18:03.865000Z",
    "date_accepted": "2025-01-18T23:01:12.526000Z",
    "date_published": "2025-05-02T16:18:00Z",
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}