Screening patients, visitors, staff at hospital entrances didn't catch much COVID-19
Of nearly 1 million individuals screened for COVID-19 symptoms or exposure at entrances of a U.S. academic medical center from March 17, 2020, to May 8, 2021, fewer than 0.1% had a failed screening. The estimated cost to identify one screening failure was $2,351.
A recent study found limited benefit to maintaining 24-hour hospital entrance screening for COVID-19 symptoms, exposures, or travel.
Researchers evaluated hospital entrance screening failure rates for patients, visitors, and health care personnel at a large U.S. academic medical center in Connecticut. The hospital implemented screening for COVID-19 at 10 of its entrances from March 17, 2020, to May 8, 2021. Criteria for a failed screening were a temperature of 38 °C (100.4 °F) or greater; any exposure to, symptom suggestive of, or positive test for COVID-19 in the prior two weeks; or recent travel to high-risk areas. Results were published as a research letter online Nov. 28 by JAMA Internal Medicine.
There were 951,033 screenings performed, with 631 (0.07%) failures (0.66 failures per 1,000 individuals screened). The rate of screening failure varied over time, peaking in March 2020 at 2.64% (26.40 failures per 1,000 individuals screened) before decreasing in subsequent months. During the first wave of the pandemic, 0.69% of individuals had a failed screening (6.94 failures per 1,000 individuals screened). After that, screening failure rates were consistent across both times of high and low community SARS-CoV-2 incidence (defined as greater than and fewer than 10 cases per 100,000 individuals averaged over a month, respectively). A total of 29.5 full-time-equivalent staff were needed to maintain 24-hour screening, costing an estimated $1,288,560 in total annual compensation (using an hourly minimum wage of $15) plus benefits (estimated at 40%). The researchers excluded managerial staff and supplies, such as gloves, masks, and thermometers, in their estimate. The minimum cost to identify one screening failure was $223.58 during the first wave and $2,350.96 across the entire study, they estimated.
A limitation of the study was that the true incidence of COVID-19 in those screened was unknown, precluding an assessment of the effectiveness of the screening strategy, the authors noted. In addition, self-reported symptoms have a low sensitivity for true infection with COVID-19, according to an accompanying editor's note.
“Surveillance screening is expensive for health care systems and a daily annoyance for those who work there. … [But] there is value in keeping all symptomatically ill workers and visitors out of the hospital—not merely those who are infected with COVID-19,” the editor's note said. “It is known that some health care workers come to work under virtually any personal health circumstance due to tacit pressure. COVID-19 surveillance screening has enabled workers to appropriately stay home when they are ill.”