5.7 Respiratory screening assessment to determine transmission risk

The process of respiratory screening assessment will vary dependant on both the health and care facility and the type of service provision but wherever possible, respiratory screening questions should be undertaken by telephone prior to an arranged arrival at the facility for all service users and any accompanying carers. If this is not possible, then these questions should be asked on arrival at reception.  This will help inform the clinical/care team of service user respiratory status and potential associated risk before face to face consultation should this be deemed appropriate. 

If respiratory screening is undertaken prior to arrival at a health and care facility, and if the service user answers ‘no’ to all of the respiratory screening questions, the service user should be reminded to inform a staff member should any symptoms develop prior to attendance at the facility. 

Below are the required respiratory screening questions determined by setting. 

Table 2 provides respiratory screening questions for care homes, prisons and social community and residential care settings.

Table 3 provides respiratory screening questions for inpatient settings

Table 4 provides respiratory screening questions for all outpatient and primary care settings inc dentistry

Table 2: Respiratory Screening Questions for use in care homes, prisons and social community and residential care settings

A word version of Table 2 is available.

COVID-19 Screening questions

Yes

No

Do you or any member of your household/family have a confirmed diagnosis of COVID-19 diagnosed in the last 10 days?


NB: Any person who has previously tested positive for SARS-CoV-2 by PCR should be exempt from being re-tested within a period of 90 days from their initial symptom onset, or the first positive test, if asymptomatic, unless they develop new possible COVID-19 symptoms. This is because fragments of inactive virus can be persistently detected by PCR in respiratory tract samples for some time following infection.

   
Do you or any member of your household/family have suspected COVID-19 and are waiting for a COVID-19 test result?    
Have you travelled internationally in the last 10 days to a country that is on the Government red list?    
Have you had contact with someone with a confirmed diagnosis of COVID-19, or been in isolation with a suspected case in the last 10 days?    
Do you have any of the following symptoms;
  • High temperature or fever?
  • New, continuous cough?
  • A loss or alteration to taste or smell?
  • Any other symptoms of a respiratory virus?
   

If the service user answers ‘Yes’ to any of the COVID-19 screening questions above, place on the respiratory pathway.

If service user answers ‘No’ to all of the COVID-19 screening questions above, proceed to general respiratory screening questions below

General respiratory screening questions

Yes

No

Do you have any new or worsening respiratory symptoms not already mentioned which suggest you may have a respiratory virus? *1    

Have you had a laboratory test confirmed respiratory virus/infection such as Influenza in the last 10 days?*2

   

If the service user answers ‘YES’ to any of the COVID-19 or the respiratory symptoms questions, place on the respiratory pathway.

Notes

*1 Note for healthcare workers (HCWs) in relation to respiratory symptoms;

List of respiratory symptoms below may indicate a respiratory virus/infection;

Rhinorrhea (Runny nose)

The following can also be symptoms of a respiratory virus but may also be related to a non-respiratory cause therefore caution should be applied in allocation of these patients to the respiratory pathway in the absence of any symptoms noted above.

*2 If the service user advises of having had a test positive pathogen in the last 10 days, they should be placed according to the infective period for that specific pathogen and an assessment of any ongoing infectivity.  Refer to A-Z of pathogens for details of individual pathogens.

 

Table 3: Respiratory Screening Questions for use in inpatients settings (with exception of care home, prisons, social community and residential care settings – these settings should refer to table 2)

A word version of Table 3 is available.

The screening questions below apply to all service users.

COVID-19 Screening question

Yes

No

Have you had a confirmed diagnosis of COVID-19 in the last 10 days?

If the individual answers YES, proceed to respiratory pathway. A laboratory based PCR test does not need to be repeated if there is evidence of a positive PCR in the last 10 days. 

If the individual answers NO, proceed to next question;

NB: Any person who has previously tested positive for SARS-CoV-2 by PCR should be exempt from being re-tested using PCR tests within a period of 90 days from their initial symptom onset, or the first positive test, if asymptomatic, unless they develop new possible COVID-19 symptoms. This is because fragments of inactive virus can be persistently detected by PCR in respiratory tract samples for some time following infection

   
Do you have any of the following symptoms;
  • High temperature or fever?
  • New, continuous cough?
  • A loss or alteration to taste or smell?
  • Any other symptoms of a respiratory virus?

If the individual answers YES, proceed to respiratory pathway and undertake a laboratory based PCR test.  A Rapid Diagnostic Test (including POCT) or LFD may also be undertaken in addition to a laboratory based PCR test to support rapid patient placement assessment on the respiratory pathway.

If the individual answers NO, proceed on the non-respiratory pathway.

   

 

Table 4: Respiratory Screening Questions for use in outpatient departments and primary care settings including dentistry

A word version of Table 4 is available.

The screening questions below apply to all service users.

COVID-19 Screening questions

Yes

No

Have you had a confirmed diagnosis of COVID-19 in the last 10 days?

If the individual answers YES, consider delaying appointment where the matter is non urgent or using digital consultation methods if not detrimental to the patient..  Where appointment must proceed face to face , do so via the respiratory pathway.

If the individual answers NO, proceed to next question. 

   
Do you have any of the following symptoms;
  • High temperature or fever?
  • New, continuous cough?
  • A loss or alteration to taste or smell?
  • Any other symptoms of a respiratory virus?

If the individual answers YES, consider delaying appointment where the matter is non urgent or using digital consultation methods if not detrimental to the patient.  Where appointment must proceed face to face, do so via the respiratory pathway.

If the individual answers NO, proceed on the non-respiratory pathway.

   

 

Primary Care and Community Health and Social Care settings - respiratory screening questions and triage

If following telephone consultation the individual meets the criteria for the respiratory pathway and if the matter is non urgent, face to face consultation should be deferred until the COVID-19 self-isolation period has elapsed or until non COVID-19 respiratory viral symptoms have resolved. 

Health and care professionals should see individuals face to face or via remote consultation, whichever is felt most appropriate where they have deemed further clinical assessment is required.  If it is necessary to review individuals on the respiratory pathway by means of a face to face consultation (regardless of the presenting problem) then they should be advised of the most suitable way to transfer to the facility, enter the health and care facility, and on arrival, should be directed to a suitable waiting area identified for symptomatic individuals.

NB: children with mild bronchiolitis and lower respiratory tract infections should be managed in primary care settings where possible to ensure a holistic primary care assessment. Planning should include the implementation of locally appropriate models of care enabling secondary care clinicians to support primary care colleagues. The expectation should be that children with mild and moderate bronchiolitis or lower respiratory tract infection are initially reviewed in primary care settings.

If providing a home visit, staff should contact the individual by telephone at home prior to the visit to undertake the respiratory screening if time allows.  These should be repeated on arrival at the individual’s home. If an individual lacks ability to answer questions by telephone, an assessment should be made on arrival ensuring that a Type IIR FRSM is worn. If this is not possible, treat as having respiratory viral symptoms until a direct assessment can be made by the care provider. Scottish Government advice on providing care at home is available.

Individuals living in residential facilities should be closely monitored for onset of respiratory viral symptoms by local care staff.

 

Dental settings – Respiratory screening questions & triage

If following telephone consultation the patient meets the criteria for placement on the respiratory pathway and if the matter is non urgent, face to face consultation should be deferred until the COVID-19 self isolation period has elapsed or other non COVID-19 respiratory viral symptoms have resolved.  If the matter is urgent, the patient may be seen within the dental setting but ideally should be provided with an appointment at the end of the day/session to reduce any post Aerosol Generating Procedure (AGP) fallow time (if an AGP is performed) impacting on the remaining patient consultation list.See section 5.15.7 Determining the IPC precautions required for AGPs.

Secondary Care settings - Respiratory screening and triage questions

Patients should be assessed for respiratory symptoms at the earliest opportunity to direct them to the safest route within the facility in line with respiratory screening questions. SAS staff should undertake the respiratory screening questions prior to arrival at the receiving Emergency Department and accompany the patient to the appropriate waiting area dependant on outcome.It is recognised that patient placement will be dependent on clinical need in addition to respiratory status.  Where a patient with respiratory symptoms cannot be placed in the respiratory cohort for clinical reasons, avoid placing the patient next to anyone high risk and previously considered to be on the shielding list, keep curtains pulled as a physical barrier if safe to do so and ensure thorough cleaning as per respiratory care pathway described in the environmental cleaning section.

Reception areas must display signage encouraging service users to report respiratory symptoms immediately on arrival and reception staff should ask all service users on arrival using the respiratory screening questions regardless of the reason for presentation at the facility and where it is safe to do so without delaying any lifesaving interventions. 

Only the service user requiring a consultation should attend health and care facilities unless a carer or escort is required.