Providers should use their best clinical judgment to prioritize testing, referencing the CDC and local health departments for guidance. Some considerations for prioritizing testing are based on availability of test in your facility, number of patients that need testing, the risk factors to the patient involved, prevalence of COVID-19 cases in your community, and if you have ruled out other illnesses (e.g., the flu).
At the outset of the COVID-19 crisis, the CDC had been recommending to not test people who have mild symptoms. However, that guidance has loosened some based on the availability of more tests. Here’s a link to latest CDC guidance on testing recommendations (including updates as appropriate).
Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.”
The CDC’s guidance on testing priority can be found here on their website.
We recommend that practices:
- Develop criteria for testing, using the CDC as your base line.
- Implement these same guidelines consistently to all patients within your practice.
- Have providers use their clinical judgement to decide who needs testing, based on the implemented guidelines.
- Discuss decisions to not perform testing with patients (if/when provider believes a patient does not meet criteria for testing). Encourage providers to deliver this message in a reassuring way, explaining to the patient why it is not advisable at this time to test, and remind them that treatment would not change based on the test.
- Instruct these patients to contact you immediately should symptoms worsen.
- Document conversations and reasoning behind your decisions.
Having these consistent practices and good documentation will help mitigate risk of treating patients differently which could lead to a potential claim of discrimination later.
There are still many unknowns at this time, which is why guidelines are constantly being updated. That leaves flexibility and judgement to the clinician to make decisions around testing, and protocols will need to be adjusted as more (and faster) tests become available.