BACKGROUND: Isolation of hospitalized persons under investigation (PUIs) for COVID-19 reduces nosocomial transmission risk . Efficient PUI evaluation is needed to preserve scarce healthcare resources . We describe the development, implementation, and outcomes of an inpatient diagnostic algorithm and clinical decision support system (CDSS) to evaluate PUIs .
METHODS: We conducted a pre-post study of CORAL (COvid Risk cALculator), a CDSS that guides frontline clinicians through a risk-stratified COVID-19 diagnostic workup, removes transmission-based precautions when workup is complete and negative, and triages complex cases to Infectious Diseases (ID) physician review . Pre-CORAL, ID physicians reviewed all PUI records to guide workup and precautions . Post-CORAL, frontline clinicians evaluated PUIs directly using CORAL . We compared pre- and post-CORAL frequency of repeat SARS-CoV-2 nucleic acid amplification tests (NAATs), time from NAAT result to PUI status discontinuation, total duration of PUI status, and ID physician work-hours, using linear and logistic regression, adjusted for COVID-19 incidence .
RESULTS: Fewer PUIs underwent repeat testing after an initial negative NAAT post-CORAL than pre-CORAL (54% vs. 67% ; aOR 0.53 , 95% CI : 0.44-0.63, p <0.01). CORAL significantly reduced average time to PUI status discontinuation (adjusted difference: -7.4 [SE 0.8] hours/patient; p <0.01), total duration of PUI status (adjusted difference: -19.5 [SE 1.9] hours/patient; p <0.01), and average ID physician work-hours (adjusted difference: -57.4 [SE 2.0] hours/day; p <0.01). No patients had a positive NAAT within 7 days after discontinuation of precautions via CORAL .
CONCLUSIONS: CORAL is an efficient and effective CDSS to guide frontline clinicians through the diagnostic evaluation of PUIs and safe discontinuation of precautions.