The Triage System Based on Health Code

The triage system implemented in this study was an update of our previous strategy with the application of Health QR Code.¹⁹ Only one entrance (hospital gate) and one exit (backdoor) were open for patients during the epidemic. Patients and medical staff had different designated one-way paths for entering and leaving the hospital. As shown in Figure 2, the 3 levels of our preliminary triage system had different tasks based on their locations and medical duties:

The flowchart of the health-code-based triage system.

Triage 1 (Entrance of outpatient and emergency department): a rapid triage through body temperature detection and health code color checking. The epidemiological history of patients and their attendants were also briefly asked.

Triage 2 (Outpatient inquiries at nurse station): a detailed inquiry of patients and their attendants’ epidemiological history was performed in this triage. The health code and body temperature were also checked in case of omitted from the first triage.

Triage 3 (By the physicians who made the first diagnosis in outpatient clinic or in-patient department): a detailed inquiry or examination of patients’ chief complaint, COVID-19 correlated symptoms,¹⁹ epidemiological history was performed in this triage. The health code and body temperature would also be checked when necessary.

In this 3-level triage system, the patients were guided to different clinics or nucleic acid testing sites according to the result of the triage assessment:

Patients with green health codes and no epidemiological history were guided to outpatient clinic. Those with fever or epidemiological history were referred to the regular fever clinic.

Patients with green health codes, fever and epidemiological history, and patients with yellow health codes and fever/epidemiology history/COVID-19 symptoms were guided to the special fever clinic and get nucleic acid test thereby. If they got negative results in two consecutive samplings, their yellow code would turn green. If they got a positive result, they would be managed as suspected cases and get a second test to confirm their infection.¹⁹

Patients with yellow health codes but had no fever, epidemiology history or COVID-19 symptoms were guided to the designated testing zone for yellow code users. Once they got a negative result, their health code would turn green after the result has been updated. If they got a positive result, they would also be managed as suspected cases and get a second test to confirm their infection.