Establishing

COVID-19
triage stations at
healthcare facilities:
Key instructions
and tips
Instructions:
The purpose of this document is to provide guidance on how to
rapidly establish a triage area at a healthcare facility (HCF). The
intended users of this document are healthcare officials/personnel
who are responsible for case management (CM) and infection
prevention and control (IPC) at the facility. Ideally, regardless of the
type of facility, each entry point into the HCF should have a triage
station, where patients will be screened for COVID-19. If triage
stations are not capable of being placed at each point of entry at the
healthcare facility level, then a single triage station where all
entrants to the facility (including staff) can be screened should be
established. This document will outline different options for setting
up a triage station based on the resources and/or size of the
healthcare facility. In this document, two triage options are being
presented. Option A is a basic triage set-up, with the minimum
requirements for a triage station, identified. Option B is a more
advanced set-up, targeted toward larger, healthcare facilities that
have the option of also conducting emergency treatment
procedures.

How to establish a triage station: Option A (primary

and secondary facilities)
1. This triage option is for small healthcare facilities, where
resources may be limited. This triage options provides the
minimum requirements for establishing a triage station.
2. At each point of entry into the healthcare facility (emergency
department, out-patient clinic, antenatal clinic, etc.), identify
space where a triage station may be placed.
3. If a structure (a building, tent) already exists at a healthcare
facility point of entry, then this space may be utilized for a triage
station.
4. If a structure does not exist, one does not need to be constructed
to set up a triage station. Do not wait to screen incoming
patients into the HCF for COVID-19 due to infrastructural
limitations. If no structure exists, then identify an area close to
the health facilities POEs (which may be outside) that is well-
ventilated.
5. Minimally, one table and two chairs can be used as a triage
station. One table and chair can be for the healthcare worker
(HCW). One chair can be for the patient. These two tables should
be 1-2 meters apart.
6. Patients who have COVID-19 symptoms should be placed in a
separated seated area from patients who are not symptomatic.
Their seats should be at least 1-meter apart.
7. In the triage area, screening forms, thermometers, hand hygiene
and PPE should be available to HCWs. If a 1-2-meter distance is
maintained by the HCW and the patient being triaged, the need
for PPE is not required.
8. An isolation space, close to triage, ideally attached to the triage
area, should be established to separate suspected COVID-19
cases from others. If it is not possible to establish an isolation
space close to the triage area, then a ward at the HCF should be
designated the isolation ward. Based on the healthcare facilities
resources, suspect cases may be further separated based on
symptoms (i.e. mild versus moderate).
9. Two pathways (one for suspects who should be isolated and one
for other patients who were screened and deemed not suspects)
should be established. The isolation pathway should lead directly
to the isolation area. The non-isolation pathway should lead to
specific HCF departments based on patient’s needs.
10. Ideally, the triage station will have one-way into the station and
one-way out of the station. In short, uni-directional flow of
patients and HCWs should be established.
11. Hand hygiene stations should be established at each triage
station and readily available throughout the waiting areas. Waste
bins should also be placed at each triage station for hand hygiene
and respiratory materials. These items can be placed in the same
bin.
12. Security (if needed) should be available at each point of entry to guide
patients, their support systems, and HCWs to triage stations for
screening.

The triage process: Option A

1. Except for patients in acute emergency (i.e. Severe respiratory distress),
ALL patients entering a point of entry into the HCF MUST be screened
at triage. Patients experiencing an emergency must be taken straight
away to a healthcare facility that provides advanced care if those
services are not available at the presenting healthcare facility.

2. All HCWs before starting their shifts at the HCF MUST also be screened,
wash they hands /clean hand using sanitizer before entering the HCF.
3. As patients and their support systems (i.e. family members, friends,
caregivers etc.) approach the triage station, they should be required to
wash their hands at the hand hygiene station. Patients who have
symptoms of COVID-19 should be provided a surgical mask while they
wait to be screened.

4. After washing their hands, they should be guided to take a seat if there
is a queue at the triage station based on if they have COVID-19
symptoms or not. Patients presenting with COVID-19 symptoms should
be seated in one area of the waiting area, while patients without
COVID-19 should be seated in another area in the waiting room,
maintaining at least a meter distance between spaces and patients.
5. As patients and their support systems wait for the screening process,
they should be reminded of the principles of respiratory hygiene (i.e.
covering the mouth and nose during coughing or sneezing with a tissue
or flexed elbow).

6. If screening is occurring inside a built structure (an already existing

building), patients and their support systems should be advised that the
support individual(s) should wait outside the building/structure until
the patient screening process is completed.

7. During the screening process, a patient will be asked to come forward

and sit in the triage chair. If a patient can stand, then standing while
being screened is best. But, if the patient is too weak or very ill, the
triage chair should be available for patients to sit. After this patient has
been triaged, this chair should be disinfected. The patient will be asked
some questions during the screening process. These questions include
demographic information, COVID-19 symptoms, travel history, and
contact history. After the questions on the screening for have been
asked of the patient, the patient’s temperature should be assessed.

8. Based on the case definition for COVID-19, if a patient is screened and

deemed a potential suspect of COVID-19 and is having mild/moderate
symptoms, then this patient should be escorted via the isolation
pathway to the isolation area.

9. If the patient is screened and deemed not to be a COVID-19 suspect,

then the patient should be escorted down the routine healthcare
services pathway into the HCF.

10. Ideally, in the isolation area, a HCW will take specimen to test the
patient. If a patient is diagnosed with COVID-19, they should be moved
to a ward with other confirmed COVID-19 cases. The patient must stay
on the confirmed ward until two RT-PRC tests are negative within a 24-
hour period until they can return to the community.
 11. If a patient is screened and deemed to be a potential suspect COVID-19
and is having severe symptoms, then this patient should be admitted to
the hospital urgently to a dedicated ICU room or ward for COVID-19
patients.

12. HCWs should frequently wash their hands while working at the triage
station. HCWs should be washing their hands at least once every 20
minutes.

Basic Triage Station Set-up (minimum requirements):

Option A

Isolation
Patient Triage Waiting Area Area
(this can be inside or outside)

With COVID-19 symptoms

HCW table with triage

Healthcare Facility 1-Meter Chair
Chair
Entrance
(can be an entrance into

HCW chair
supplies
Triage chair

the physical HCF 2-Meter

structure or the HCF
grounds (i.e. entry gate) 2-Meter

Without COVID-19 Symptoms

Chair 1-Meter Chair HCF

Departments
Non-suspect Pathway

How to establish a triage station: Option B (large,

academic health facilities or tertiary facilities)
1. This triage option (Option B) is intended for larger healthcare facilities
or systems that have the resources and ability to set up a combined
triage/emergency care center at a single point of entry at the
healthcare facility.
2. The benefits of a combined triage/emergency center are that patients
who are in critical condition can gain access to healthcare facility
services in an expediated manner.
3. For this triage option, a basic infrastructure will need to be built, using
tents, if an existing structure is not already available at the healthcare
facility. An area for patient triage should be established as patients
enter the healthcare facility, and the emergency care area should be
established adjacent to the triage area. The triage structure of this
triage/emergency care center should be open and well-ventilated.
4. For the triage area, two separate triage stations should be established.
A primary triage area should be established at the point of entry into
the healthcare facility, where patients are rapidly screened for COVID-
19 symptoms. A second triage station should be placed after the first
for further patient clinical assessment.
5. After the second triage is established, an isolation space should be
established. Inside the isolation area, there should be two areas: one
for emergency, critical care for severe cases, one for suspected cases
with mild or moderate symptoms. Inside the suspect isolation area,
cases should be sub-dived based on patients with mild symptoms being
placed together and patients with moderate symptoms being placed
together.
6. Outside the isolation area, a laboratory should be established to rapidly
test those suspects with mild or moderate symptoms. If possible, for
cases requiring emergency care, a test sample should be collected.
7. Inside the isolation area, there should also be the emergency care area
where patients with severe symptoms are rapidly placed for emergency
care. Inside this emergency care area, supplies, medical equipment,
and PPE should be available to care for a rapidly declining patient.
Emergent medical services to stabilize the patient should be properly
set-up in this space.
8. An annex to this document (Annex A) outlines the required supplies
and medical equipment needed to establish the triage/emergency care
center. The supplies and medical equipment in this Annex are meant to
serve 100 patients for 1-month.
9. At the entry point of the healthcare facility, where the first triage
station is established, hand hygiene stations should be set up. Waste
bins should be placed by the hand hygiene stations to collect used
tissues.
10. Both triage stations should be well-equipped with PPE, screening
forms, and thermometers.
11. At both triage stations, a least 1-meter distance should be maintained
between the healthcare worker and patient if possible.
12. The triage/emergency care center should have one-way flow throw the
center. There should be one-way in and one-way out.
13. Security (if needed) should be available at the point of entry into the
healthcare facility to guide patients, their support systems, and HCWs
to the primary triage station for screening.
14. Of note, Option A would be the equivalent of “Triage 1” under Option B
(see diagram)
The triage process: Option B
1. ALL patients and healthcare workers (HCWs) entering the healthcare
facility MUST be screened. Where possible, separate screening points
should be established for HCW and Patients to minimize risk of HCW
exposure.
2. Upon entry into the healthcare facility, at the first triage station, HCWs
and patients should be screened for COVID-19(Preferably at separate
screening points where possible. If the HCW or the patient is not
identified as a COVID-19 suspect, then these individuals may proceed to
their clinical departments within the healthcare facility.
3. As HCWs, patients and their support systems (i.e. family members,
friends, etc.) approach the first triage station, they should be required
to wash their hands at the hand hygiene station. HCWs and patients
who have symptoms of COVID-19 should be provided a surgical mask
while they wait to be screened. The distance between the HCW and
the patient at the first triage station should be at least 1 meter.
4. If the HCW or patient is identified as a COVID-19 suspect, then they
should proceed immediately to the second triage station. At the second
triage stations, patients’ clinical conditions will be further assessed and
evaluated based on their symptoms (i.e. mild, moderate, or severe
symptoms).
5. If there is a queue at the second triage station, patients presenting with
COVID-19 symptoms should be seated in one area of a waiting area,
while patients without COVID-19 symptoms should be seated in
another area in the waiting room, maintaining at least a meter distance
spaces between patients.
6. As patients and their support systems wait for the screening process,
they should be reminded of the principles of respiratory hygiene (i.e.
covering the mouth and nose during coughing or sneezing with a tissue
or flexed elbow).
7. At the second triage station, if the patient is having a medical
emergency, they should be quickly placed into the emergency care area
of the triage/emergency care center, which may function as an on-site
ICU if needed. The emergency care area is an area considered under
isolation. Emergency medical services to stabilize the patient should be
available in the emergency medical area. Once the patient is stabilized
and can be moved, they should be moved to the suspected isolation
area, while test results are pending.
8. At the second triage station, if the patient is not having a medical
emergency, they will be called by a HCW to be further assessed.

9. During the second screening process, a patient will be asked to come

forward and sit in the triage chair. If a patient can stand, then standing
while being screened is best. But, if the patient is too weak or too ill,
the triage chair should be available for patients to sit. After this patient
has been triaged, this chair should be disinfected. The HCW conducting
the triage should be sitting in a chair (with or without a table in front of
them) that is at least 1 meter away.
10. After the second triage process, patients who are suspected COVID-19
suspects (that are not having a medical emergency) should be placed
into a separate space from the emergency care area based on their
symptoms (i.e. mild versus moderate). This separate area is also
considered under isolation.
11. As quickly as possible, COVID-19 suspects in the mild or moderate
isolation area should be tested. If they are found to be positive, they
should be moved to another ward at the healthcare facility where
other positive COVID-19 cases are cohorted, if no single-patient rooms
are available.
 Advanced Triage/Emergency Care Center Set-up:
Option B
Advanced Triage/Emergency Care Center Set-up: Option B

Suspected Cases
Patient Triage Waiting Area
(this can be inside or outside)

With COVID-19 Symptoms Moder

Mild
ate
cases
cases
Chair 2-Meter Chair

HCW table with triage

supplies
Triage chair

HCW chair
2-Meter 2-Meter Emergency Care
Center
Without COVID-19 Symptoms (Severe cases
requiring
Chair
stabilization
2-Meter Chair
See ANNEX A for list
of supplies and
medical equipment)
HCF
Departments

Triage 2

COVID-19
Laboratory
[-] Triage 1 [+]

Healthcare Facility
Entrance
Entrance into the HCF
grounds (i.e. entry gate)