Implementation of a Triage Protocol Outside the Hospital Setting for Timely Referral During the COVID-19 Second Wave in Chennai, India

Alby John; Jagadeesan M; Polani Rubeshkumar; Parasuraman Ganeshkumar; Hemalatha Masanam Sriramulu; Manish Narnaware; Gagandeep Singh Bedi; Prabhdeep Kaur

doi:10.2196/42798

Implementation of a Triage Protocol Outside the Hospital Setting for Timely Referral During the COVID-19 Second Wave in Chennai, India

JMIR Form Res. 2023 Dec 18:7:e42798. doi: 10.2196/42798.

Authors

Alby John¹, Jagadeesan M¹, Polani Rubeshkumar², Parasuraman Ganeshkumar², Hemalatha Masanam Sriramulu¹, Manish Narnaware¹, Gagandeep Singh Bedi¹, Prabhdeep Kaur²

Affiliations

¹ Greater Chennai Corporation, Government of Tamil Nadu, Chennai, India.
² Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India.

PMID: 37235721
PMCID: PMC10758940
DOI: 10.2196/42798

Abstract

India experienced a surge in COVID-19 cases during the second wave in the period of April-June 2021. A rapid rise in cases posed challenges to triaging patients in hospital settings. Chennai, the fourth largest metropolitan city in India with an 8 million population, reported 7564 COVID-19 cases on May 12, 2021, nearly 3 times higher than the number of cases in the peak of COVID-19 in 2020. A sudden surge of cases overwhelmed the health system. We had established standalone triage centers outside the hospitals in the first wave, which catered to up to 2500 patients per day. In addition, we implemented a home-based triage protocol from May 26, 2021, to evaluate patients with COVID-19 who were aged ≤45 years without comorbidities. Among the 27,816 reported cases between May 26 and June 24, 2021, a total of 16,022 (57.6%) were aged ≤45 years without comorbidities. The field teams triaged 15,334 (55.1%), and 10,917 (39.2%) patients were evaluated at triage centers. Among 27,816 cases, 19,219 (69.1%) were advised to self-isolate at home, 3290 (11.8%) were admitted to COVID-19 care centers, and 1714 (6.2%) were admitted to hospitals. Only 3513 (12.7%) patients opted for the facility of their choice. We implemented a scalable triage strategy covering nearly 90% of the patients in a large metropolitan city during the COVID-19 surge. The process enabled early referral of high-risk patients and ensured evidence-informed treatment. We believe that the out-of-hospital triage strategy can be rapidly implemented in low-resource settings.

Keywords: COVID-19; India; LMIC; community health; health care system; health disparity; implementation; low income; low- and middle-income countries; low-resource setting; patient care; pulse oximeter; self-management; triage.

©Alby John, Jagadeesan M, Polani Rubeshkumar, Parasuraman Ganeshkumar, Hemalatha Masanam Sriramulu, Manish Narnaware, Gagandeep Singh Bedi, Prabhdeep Kaur. Originally published in JMIR Formative Research (https://formative.jmir.org), 18.12.2023.