New Tool Helps Clinicians Assess Persons Under Investigation for COVID-19 More Quickly

February 11, 2021

A new real-time tool is an efficient and effective clinical decision support system to guide frontline clinicians through the diagnostic evaluation of persons under investigation (PUI) for coronavirus disease 2019 (COVID-19), and when it’s safe to discontinue precautions.

The COVID Risk Calculator (CORAL) was developed and validated in a study published in Clinical Infectious Diseases.

“Isolation of hospitalised persons under investigation for COVID-19 reduces nosocomial transmission risk,” wrote Caitlin Dugdale, MD, Massachusetts General Hospital, Boston, Massachusetts. “Efficient PUI evaluation is needed to preserve scarce healthcare resources. We describe the development, implementation, and outcomes of an inpatient diagnostic algorithm and clinical decision support system to evaluate PUI.”

When using CORAL for a patient with symptoms of COVID-19, a clinician answers several questions about the patient’s risk factors, symptoms and imaging findings, and is guided through a standardised COVID-19 diagnostic workup of the patient based on up-to-date guidelines.

“We designed the CORAL tool to be easy for frontline clinicians to use and also to help ensure patient and health care personnel safety,” said Erica Shenoy, MD, Massachusetts General Hospital. “By standardising the approach to the assessment of patients with symptoms of COVID-19, we minimise the chance that a patient with a false-negative test escapes detection, which could put other patients and health care personnel at risk of exposure.”

In the study, CORAL dramatically reduced the time required by clinicians to assess patients, and it decreased the average time that hospitalised patients were kept in isolation during evaluation for COVID-19. Among 2,000 patients assessed with CORAL, none had a positive COVID-19 test within 7 days after discontinuation of precautions via CORAL.

In addition, fewer PUIs underwent repeat testing after an initial negative nucleic acid amplification test after CORAL was implemented (54% vs 67%; P

Since CORAL’s launch in May 2020, it has been used more than 30,000 times and is now in place at 8 acute care hospitals in the Boston area, as well as 4 rehabilitation hospitals. Importantly, CORAL can be rapidly adapted as new guidelines or research related to COVID-19 diagnostics emerge.


SOURCE: Massachusetts General Hospital