Phone Screening Script

[] = Action

() = Fill-in

 

Pre-Screening | identifying Target Screening Population

 

[Query electronic patient database / master patient index for target at-risk populations]

  1. Risk Factors / Co-morbidities / Past Medical History

 

Table 1. COVID-19 Risk Factors / Co-morbidities / Past Medical History

Demographics

Elderly population

Cardiology

Cardiovascular disease (e.g. Hypertension)

Pulmonology

Asthma, COPD

Gastroenterology

Liver disease

Endocrinology

Diabetes

Nephrology

Chronic kidney disease

OBGYN

Pregnancy

 

2. Recent visit (COVID-19 pandemic timeframe) with chief complaint or symptoms matching the following:

 Table 2. COVID-19 Symptoms

Cough

Sore throat and related pharyngeal symptoms (odynophagia, dysphagia, hoarseness)

Sneezing

 

Fever

Headaches

Hypogeusia / Loss of taste

Fatigue

Chills

Anosmia / Loss of smell

Sputum production

Nasal congestion

Anorexia / Poor appetite

Dyspnea / shortness of breath

Nausea / Vomiting

 

Muscle aches

Diarrhea

 

 Table 3. COVID-19 Severe Signs and Symptoms

Severe dyspnea / shortness of breath at rest

Oliguria / decreased urine output

Severe difficulty in breathing

Hemoptysis / blood in the sputum

Moderate – severe chest pain or pressure

Nuchal rigidity / stiff neck

Cold, clammy, pale or mottled skin

Acute onset of confusion

Cyanosis of extremities or mucous membranes

 

 

[Apply population health management: Prioritization via Risk Stratification methods (e.g. condition counts)]

 

 

Screening Initiation / Greeting

 

<If patient-initiated> “Thank you for calling ____________ (HCCN/CHC). How can I help you?”

<if provider-initiated> “Hi! My name is _______________. I am a (Title: MD/RN/NP/PA/MA, etc.) with (HCCN/CHC). How can I help you?”

 

(“How can I help you?” -> Chief Complaint)

  • If chief complaint is purely information-seeking, provide appropriate education *

 

[Confirm patient’s identity]

[Confirm patient’s location]

[Note patient’s phone number / contact information]

[Ensure patient’s privacy and informed consent]

 

** Rapid Assessment: Call 911 if the patient sounds very sick or distressed, then perform [EDUCATION]**

 

[EDUCATION]

Provide information using the CDC website and other sources for relevant local public health information.

 

 

Start Phone Triage and Clinical Evaluation

 

Chief Complaint: *Record as verbatim

 

History of Present Illness

  • * Elicit Signs and Symptoms by using open-ended questions instead of specific/directed questions **

 

Cough

Dyspnea

  1. How is your breathing?

  1. Can you describe your cough?

Fever

Chills

  1. Have you felt unusually hot or cold recently?

  1. If you had fever, did you check with a thermometer?

Fatigue

Muscle aches

Shortness of Breath

  1. How has your energy and activity level been?

  1. Have you had any unusual trouble breathing when doing your usual activities?

Headaches

  1. Have you had any pain in any part of your head or body?

Sore throat and related pharyngeal symptoms (odynophagia, dysphagia, hoarseness)

Nasal congestion

Sneezing

Anosmia / Loss of smell

  1. Have you had any problems around your nose and throat?

  1. Have you noticed anything unusual with smelling or breathing?

Nausea / Vomiting

Diarrhea

Hypogeusia / Loss of taste

Anorexia / Poor appetite

  1. How has your appetite been?

  1. Have you noticed any stomach issues?

  1. Have you had any abdominal discomfort or bowel issues?

 

O – Onset (How / When did it happen?)

P – Provocation / Palliation (Is there anything that makes it better or worse?)

Q – Quality (Can you describe it for me?)

R – Region and Radiation (Where is the problem and does it radiate to any other part of the body?)

S – Severity (From a scale of 0 to 10, how severe do you think the problem is?)

T – Timing (Has it changed since it started? Is it better at different times of the day?)

 

[Ask questions specific to: Table 1. COVID-19 Risk Factors / Co-morbidities / Past Medical History]

 

Exposure and Contact Tracing

 

“Have contact with someone who was diagnosed with COVID-19?”

“Live in or visit a place where COVID-19 is spreading?”

 

 

Screen for special circumstances

 

“Do you/they live in a nursing home or other long-term care facility?”

 

“In the last two weeks have you/they worked or volunteered in a hospital, emergency room, clinic, medical office, ambulance service, first responder services, or any health care setting, or taken care of patients as a student as a part of your/their work?”

 

[Ask SDOH-related questions]

 

Disposition

[Use information provided by severity of symptoms, exposure, and co-morbidities to determine appropriate disposition.]