7.1 COVID-19 case definitions and triage

7.1.1 Definition of a confirmed case

7.1.2 Definition of a suspected case

7.1.3 Testing

7.1.4 Triaging individuals

 

7.1.1 Definition of a confirmed case

A laboratory-confirmed (detection of SARs-CoV-2 RNA in a clinical specimen) case of COVID-19.

7.1.2 Definition of a suspected case

The case definition being used across the UK reflects current understanding from the epidemiology available and may be subject to change.  Case definitions can be found within Public Health Scotland (PHS) primary care guidance and below.

An individual meeting one of the following case criteria taking into account atypical and non-specific presentations in older people with frailty, those with pre-existing conditions and patients who are immunocompromised; (further information on presentations and management of COVID-19 in older people and Scottish Government and Appendix 1 :Think COVID:Covid-19 Assessment in the Older Adult - Checklist).

Community definition:

or

or

Definition for individual who may require hospital admission:

or

or

or

Individuals must be assessed for bacterial sepsis of other causes of symptoms as appropriate

7.1.3 Testing

Clinicians should test all individuals who meet either of the case definitions described in section 7.1.1.  Further information on testing can be found in the PHS Primary Care guidance.

Guidance for coronavirus testing including who is eligible for a test, how to get tested and the different types of test are available on the Scottish Government web site.

7.1.4 Triaging individuals

The mechanism for triage will vary dependant on both the geographical location and service within primary care but wherever possible, triage questions should be undertaken by telephone prior to an arranged arrival at the facility.   

To enable early detection of suspected or confirmed COVID-19, triage questions should be undertaken again on arrival at community health facilities. 

For unplanned arrivals, triage questions should be completed immediately on arrival where it is safe to do so without delaying any necessary immediate lifesaving interventions. 

Individuals with symptoms consistent with COVID-19 could present to your facility. Information posters for NHS settings should be displayed so they can be seen before individuals enter the premises, encouraging them to return home and be advised to contact NHS24. Posters are available on NHS Inform.

If providing a home visit, staff should contact the patient/individual by telephone at home prior to the visit to undertake the triage questions.  These should be repeated on arrival at the patient/individual’s home. 

If patient lacks capacity to answer these questions by telephone, an assessment should be made on arrival keeping 2 metres from the individual where possible.  If this is not possible, treat as medium risk category or high risk category if COVID-19 symptoms can be observed.

If it is an emergency and you need to call an ambulance for an individual, dial 999 and inform the ambulance call handler of the concerns about COVID-19 infection. While awaiting ambulance transfer, show the individual into a room and ask that they wear a fluid resistant surgical mask where it can be tolerated. Leave the room if safe to do so. If you have to enter the room, stay at least 2 metres away from the individual if possible and if not, wear PPE in line with section 7.5.  The room should be cleaned as per section 7.7 once the patient safely leaves the premises.

Staff within residential and detention settings must ensure individuals are monitored for new onset of any symptoms and action taken at the earliest opportunity.

The following are examples of triage questions:

If yes, wait until self-isolation period is complete before admission or if urgent care is required, follow the high-risk category.

If yes, ascertain if appointment/consultation/home visit can be delayed until results are known.  If urgent care is required, follow the high risk category.

If yes, 10 days’ self-isolation will apply.  Only urgent care should be provided during the self-isolation period.  The individual should be placed on the medium or high risk category depending on a clinical and individual assessment – see footnote 1 in section 7.2 (See Scottish Government list of countries exempt from self-isolation).

If yes, wait until self-isolation period is complete before admission or if urgent care is required, follow the high-risk category.

If yes, provide advice on who to contact (GP/HPT) and follow high-risk category.

If No, remind individual to wear face covering on arrival or supply facemask.

A word version of these questions for triage is available to download.