I work at a small critical access rural hospital. I just wanted to get other nurses thoughts on my ED's practice of not allowing patients in to the ED that have symptoms consistent with or have had a known or possible exposure to COVID without first swabbing and rapid COVID testing them. We go out to their car to obtain a swab and send it to lab they stay in side their car in our parking lot until results come back, roughly 30 min. If it is positive and they still want to see the provider they are taken to our only neg pressure iso room through a back entrance to the hospital. If results are neg and they still want to see the provider they come in through our regular entrance and ED. I feel this is not a safe practice much less one that is best practice and is possible even contrary to CMS regulations. First EMTALA regulations state if a patient presents to an ED requesting medical evaluation one must be done expeditiously which requires a Provider to see them. We register them on arrival and then we the RNs order the COVID test without a provider actually seeing them or ordering any tests. We put the order in as a verbal order because we do not have a policy or even a standing order set for the screen. They stay in our parking lot which makes them our responsibility. No one is outside to observe if a deterioration occurs. No vital signs are taken until they present inside the hospital. A good percentage of the time the patients sign out "AMA" after the results come back because they just wanted a COVID screen that we do not offer through our ED as the only reason for seeking care. When I questioned the safety and legality of this practice I was told, that was the way it was going to be done. The reason, to avoid the facility being "contaminated" or risk an exposure to other people because we have one neg pressure room in the hospital and it is on the floor. I was told if I was really that concerned I could go out to the parking lot and assess the patient. This is an untenable idea, I can't be outside assessing people in their cars with patients in ED. The providers never know the patient is in parking lot until COVID test is back so they obviously can't order meds, labs or treatments. I question the accuracy of our rapid swab process so using it as our only plan to protect people and prevent spreading COVID is not a good action plan. Finally the symptoms of COVID are so varied and ever evolving that almost anything could be "a symptom" like pneumonia, COPD exacerbation, a MI and sepsis to name a few. This is far from an exhaustive list of issues to patient care and risk management that I see. I did not ask but I will assume if the complaint is consistent with imminent loss of life or limb they would be brought directly into our ED. I am concerned for many reasons first and foremost my patient's safety and my licensure. Any thoughts or advice would be appreciated, especially any direct knowledge of regulations that are directly on point forbidding such actions.
Thank you for your input
Stephanie L Hopwood RN CEN
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Stephanie Hopwood RN CEN
Patient Care Coordinator
CHI Lakewood
Baudette MN
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