ClearTriage and Schmitt-Thompson Clinical Content responded quickly to the COVID-19 pandemic early in 2020, providing nurse telephone triage protocols for COVID-19 for all ClearTriage customers and a free version of ClearTriage with just the COVID-19 protocols to support COVID-19 hotlines. We regularly updated the COVID-19 protocols over the following 3 years. This blog article details the timeline of those updates. As of September 2022, the plan is to update the COVID-19 protocols only as part of the annual protocol update cycle.
Original February 7, 2020 Article
With so much news about the coronavirus (COVID-19) outbreak in China, many healthcare facilities are already receiving calls from patients concerned about exposure or travel. We are pleased to announce that both the Office Hours and After Hours versions of ClearTriage now include Coronavirus Exposure telephone triage protocols to help your triage nurses field these calls.
Dr. Barton Schmitt and Dr. David Thompson and their teams have been monitoring the situation and working closely with the Centers for Disease Control to develop these protocols. As this is a new and rapidly changing situation, we recommend using these protocols in conjunction with your nursing experience and having reviewed the most current information on the CDC website.
We anticipate that the Schmitt-Thompson protocol authors will be releasing periodic and possibly rapid updates to these protocols. Following our commitment to provide the best possible triage experience to our customers, we made these protocols available in ClearTriage within 24 hours of their release and will continue to provide updates in a timely manner as they become available.
Updates March 10, 2020
The two adult protocols have been updated.
Updates March 12, 2020
The two pediatric protocols have been updated.
Updates March 19, 2020
The two adult protocols have been updated, both in ClearTriage and in the links below. In addition, we’ve written this blog article describing how you can customize the Cough, Fever, and other respiratory protocols to handle possible COVID-19 cases. And we’ve released a free COVID-19 only version of ClearTriage. (Note: this free COVID-19 only version of ClearTriage was retired in April 2021.)
Updates March 29, 2020
After Hours versions of a new COVID-19 Diagnosed or Suspected protocol have been released along with major updates to the COVID-19 Exposure protocol. Together these two protocols work together to offer broad triage support, whether you are in an area of high (major) community spread or an area of low (minor) community spread. Office Hours versions of these updates will be released soon.
Updates April 1, 2020
Office Hours versions of the new COVID-19 Diagnosed or Suspected protocol have been released along with major updates to the Office Hours versions of the COVID-19 Exposure protocol. Just like the After Hours versions released March 29th, these two protocols work together to offer broad triage support, whether you are in an area of high (major) community spread or an area of low (minor) community spread.
Updates May 20, 2020
New versions of all COVID-19 protocols were released. Here is a summary of the updates:
- The COVID-19 Exposure protocol now only covers patients who have NO symptoms.
- The COVID-19 Diagnosed or Suspected protocol now covers all patients who have symptoms consistent with COVID-19 and/or have tested positive.
- Additional Symptoms: The list of symptoms prompting suspicion of COVID-19 has been expanded per new CDC guidelines.
- Multiple Protocols: Triage questions and care advice have been expanded in an effort to reduce the need to refer to additional, symptom-specific protocols when triaging a patient with suspected COVID-19. However, the triage nurse should always use clinical judgment to decide whether a second symptom protocol (e.g., Chest Pain, Fever, Headache) should be used in addition to the COVID-19 Diagnosed or Suspected protocol. Adult patients in particular may have multiple factors that make assessment and triage more complex.
- COVID-19 Testing: There was a major rewrite of these sections. Testing availability, products, and sites vary greatly based on your location. Please review the testing information in the protocols with your team to determine how your organization will discuss testing with patients.
- Kawasaki Disease related to COVID-19 (Pediatrics): Background Information and a triage question were added in the COVID-19 Diagnosed or Suspected protocol to address this rare but serious concern.
Updates July 13, 2020
New versions of all COVID-19 protocols were released. The changes are minor compared to past releases of these protocols, updating them as necessary with current guidance. You can review specific changes using the links above.
Updates August 3, 2020
New versions of the COVID-19 Diagnosed or Suspected protocols were released. There was just one minor change made in these protocols: the CDC changed their guidance on when to discontinue home isolation for a person who is diagnosed with COVID-19. They reduced the recommended time interval without fever from 72 hours to 24 hours.
And on September 10th new versions of the five pediatric COVID-19 care advice handouts were released with changes matching the September 8th changes in the nurse triage protocols.
Updates November 19, 2020
New versions of all COVID-19 protocols were released. The COVID-19 Diagnosed or Suspected protocols were updated with questions so they can be used for flu-like symptoms, whether from COVID-19 or seasonal influenza. Some triage questions were also assigned to new categories based on updated CDC guidance and to reduce unnecessary calls to PCPs, and “Get a Flu Shot” care advice was improved. The COVID-19 Exposure protocols have an updated definition of close contact (“a total of 15 minutes or more during a 24-hour period”), plus updated guidance on getting a COVID-19 viral test. Additional minor changes were made in all of the COVID-19 protocols. Detailed changes can be reviewed in the “Changes in the … protocols since the last version” links above.
Updates December 24, 2020
New versions of the three pediatric COVID-19 care advice handouts were released (just the handouts, not the protocols) along with one new pediatric COVID-19 handout:
- COVID-19 or Influenza – How to Tell (NEW)
- COVID-19 Diagnosed or Suspected
- COVID-19 Exposure – No Symptoms
- COVID-19 Prevention
Updates January 8, 2021
A new Coronavirus – Vaccine Questions and Reactions protocol was released (for adults only since the vaccine is not currently available for pediatric patients). Very minor changes to the existing adult COVID-19 protocols were also released, most notably changing the recommendation for viral testing of people who have been exposed and are asymptomatic from 6-8 days to 5-7 days, and new information in the Background about CDC’s new options for testing after exposure.
Updates March 26, 2021
New versions of all COVID-19 protocols were released. They included the following updates:
- Updated vaccine information
- For adults, guidance on what they can safely do after they are fully vaccinated
- New “Use a Different Protocol If” suggestions based on patient’s completed vaccination status or recent positive COVID-19 test status
- Shortened COVID-19 titles to remove the unnecessary word “Coronavirus”
- Other minor changes
Updates May 26, 2021
New versions of the After Hours COVID-19 protocols were released as part of the 2021 After Hours protocol updates. They included the following updates:
- COVID-19 – Persisting Symptoms Follow-Up Call. This is a new adult protocol for those previously diagnosed with COVID-19 and who have symptoms lasting 3 or more weeks.
- COVID-19 pediatric vaccine information was added to the pediatric Immunization Reactions protocol (triage questions and care advice) and the pediatric COVID-19 Exposure protocol (background information only).
- Other minor changes
Updates June 2, 2021
New versions of the Office Hours COVID-19 protocols were released to match changes made in the May 26th After Hours updates. The new versions included the following updates:
- COVID-19 pediatric vaccine information was added to the pediatric Immunization Reactions protocol (triage questions and care advice) and the pediatric COVID-19 Exposure protocol (background information only).
- Other minor changes
Note: The Office Hours version of the adult COVID-19 – Persisting Symptoms Follow-Up Call protocol will be released in a few months as part of the 2021 Office Hours protocol updates.
Updates June 3, 2021
New versions of the four pediatric COVID-19 care advice handouts were released (just the handouts, not the protocols) along with one new pediatric COVID-19 handout: COVID-19 Vaccines – Answers to Common Questions.
Updates July 26, 2021
The initial release of the Office Hours version of the adult COVID-19 – Persisting Symptoms Follow-Up Call protocol. Plus very minor updates to the other Office Hours COVID-19 protocols.
Updates September 8, 2021
New versions of all of the COVID-19 protocols were released to reflect changes in CDC guidance and new research information including the following updates:
- Changes in mask guidance
- Because of the Delta variant (and other possible future variants) current recommendations for wearing masks are similar for people who are vaccinated or unvaccinated.
- Changes in testing guidance
- Symptoms: All people who have symptoms of COVID-19 should get tested within 3 days of becoming ill.
- Close Contact Exposure: All people who have had close contact with someone confirmed to have COVID-19. This includes all people who live with someone confirmed to have COVID-19. Unvaccinated or partially vaccinated people should get tested immediately. If the test is negative, then testing should be repeated 5 to 7 days after exposure. Vaccinated people get tested 3 to 5 days after exposure.
- Unvaccinated and Crowded Events: Unvaccinated or partially vaccinated people who have taken part in crowded indoor or outdoor events (e.g., concerts, festivals, rallies, weddings) should get tested immediately. If the test is negative, then testing should be repeated 5 to 7 days after exposure.
- Information about breakthrough infections
- Changes in vaccine recommendations (boosters, pregnant women…)
Updates December 2, 2021 (14th Version)
New versions of all of the COVID-19 protocols were released to reflect changes in CDC guidance and vaccine policy including the following updates:
- Updated information on COVID-19 vaccination and boosters, including approval for children age 5 and older.
- Updated information on when to get testing after exposure (5 to 7 days).
- Clearer guidance on triage of patients with COVID-19 infection suspected by caller or triager, who have mild symptoms (cough, fever, or others), and have not gotten tested yet.
- Updated care advice for “Ongoing Close Contact (Household)” e.g., exposures in a family unit.
- Updated COVID-19 Questions section in the Pediatric Immunization Reactions and COVID Exposure protocols, including adding common Vaccine Postponement Questions in Home Care.
- Clarification that a positive lab test includes PCR or rapid self-test kit.
- Updated information on treatment.
- Added guidance on international travel and COVID-19 testing.
- New FAQ on Ivermectin.
New versions of the pediatric COVID-19 care advice handouts were also released with similar changes.
Updates February 7th, 2022 (15th Version)
New versions of all of the COVID-19 protocols were released to reflect changes in CDC guidance and vaccine policy. In addition, a new pediatric protocol specifically for COVID-19 Vaccine Reactions and Questions was released and the COVID-19 vaccine information was removed from the general pediatric Immunization Reactions protocol.
Detailed changes can be viewed in the links above, but the new versions include the following updates:
- Updated information on variants, including Omicron.
- Updated information on the duration of home isolation (sick) and quarantine (exposed) based on CDC guidance 01/20/2022.
- Updated information on COVID-19 vaccination (5 years and older) and boosters (12 years and older) based on CDC guidance 01/07/2022.
- Updated information on vaccine status definitions based on CDC guidance 01/16/2022.
- Changed triage disposition for healthy mildly-symptomatic people who have not tested yet from Call PCP to Home Care. Home test kits for COVID-19 are available. Patient can also get tested for COVID-19 by their doctor (or NP/PA), a retail clinic, urgent care center, or PHD testing site.
- Changed triage disposition for asymptomatic close contact exposures from Call PCP (or Call Back by Nurse) to Home Care in the Exposure protocols.
- Added a reminder for newer triagers that patients with a positive COVID-19 test but no symptoms can be managed by going directly to the Home Care disposition level triage questions in the Diagnosed or Suspected protocols.
- Plus additional smaller updates in the background information, triage questions, and care advice. Detailed changes can be reviewed in the Redlines above.
New versions of the pediatric COVID-19 care advice handouts will be released soon with similar changes.
Updates April 21st, 2022 (16th Version – After Hours Only)
New versions of all of the COVID-19 protocols were released as part of the 2022 annual After Hours update. The changes were minor, so new Office Hours versions won’t be released until the annual update of those protocols this summer.
Updates July 18, 2022 (17th Version – Office Hours Only)
New versions of all of the COVID-19 protocols were released as part of the 2022 annual Office Hours update. The changes were relatively minor.
Updates September 13, 2022 (18th Version)
New versions of all three pediatric COVID-19 protocols and three of the four adult COVID-19 protocols were released to reflect changes in CDC guidance and vaccine policy. The new versions include the following updates:
- Updated information on isolation (when a person is sick) and removed recommendations for quarantine (after a person was exposed). Of note is that asymptomatic exposed people do not need to quarantine unless they develop symptoms.
- Updated information on when testing should be performed. Highlighted that repeat testing may be needed if a rapid self-test is negative.
- Updated information on approval for COVID-19 vaccination for those children 6 months and older.
ClearTriage is a web-based decision support tool for telephone triage nurses and the leading provider of the Schmitt-Thompson telephone triage protocols. Contact us to learn more or start your 30-day free trial today.
