497 - Impact of a customized travel and exposure screening tool during the COVID-19 pandemic

Background: Screening for communicable diseases at entry to any healthcare setting due to a patient’s travel or exposure history is an important tenet of reducing transmission of pathogens among patients and healthcare providers.  We identified multiple screening tools across our enterprise leading to inconsistent documentation by staff and inability to rapidly change screening questions. We aimed to develop a customized screening tool within our electronic health record to address these challenges and provide real-time screening data to our Department of Infection Prevention.

Methods: Stakeholders from all clinical areas as well as family consultants and registration staff provided input on needs for an optimized screening tool.  Process mapping across clinical areas of prior screening tools identified variation in decision support and screening questions for both countries and diseases, and demonstrated lack of clear communication between registration staff and clinical teams.   Questions and decision support needed to identify communicable diseases in a waiting room setting were identified with stakeholders.  Our informatics team reviewed multiple tool options available in the EHR including a built-in travel module with print groups and best practice alerts, a smartform, and flowsheets.

Results: Our informatics team designed a universal flowsheet with cascading rows that included clinical decision support with travel, exposure, and symptom screening. During the period of peak COVID-19 transmission in our region, an average of 1644 patients were screened daily.  Of those, 2.8% screened positive for travel to an area of increased transmission with 14.9% of those who traveled reporting respiratory symptoms.  An additional 4.1% of total patients screened positive for exposure to COVID-19, while 7.7% reported respiratory symptoms. Nine real-time updates to locations of increased disease transmission and symptoms have been made.Customized travel and exposure screening flowsheet cascade


Conclusion: Utilizing a custom-built flowsheet model in our EHR permitted real time changes to screening to support appropriate use of infection prevention measures.  Customizable travel and exposure screening is critical for identification of patients with concern for COVID-19 and other emerging pathogens.