Likelihood of Emergency Department Patients to Follow Isolation Guidelines With Positive and Negative Viral Testing: A Survey Study

In 2024 the Centers for Disease Control and Prevention (CDC) updated its respiratory virus (RV) isolation guidelines, recommending universal isolation precautions for covid, Influenza and all other RV. Viral testing has not been shown to significantly decrease rates of ED antibiotic prescription, length of stay, or return ED visits. However, ED patients’ willingness to isolate in the absence of testing in a post-pandemic era is unknown. Therefore, the study objective was to assess patient’s self-reported willingness to follow isolation guidelines in the setting of positive versus negative RV testing.

A convenience sample of adult, English-speaking patients at an urban, academic ED (>100,000 visits) were surveyed about their preference for RV testing and likelihood to isolate in different scenarios. Using a five-point Likert scale, respondents were asked how likely they would be to isolate if they had a positive covid/influenza test. They were then asked how likely they would be to isolate with a negative covid/influenza test but a clinical diagnosis of RV and clinician recommendation to isolate. Responses were dichotomized (very likely/likely versus neutral/unlikely/very unlikely). Demographic characteristics were summarized. Frequencies of Likert responses are reported. Associations between demographic characteristics and behavior change based on testing were evaluated.

279 patients were approached; 253 (90.6%) completed the survey. The mean age was 45 years (sd 16) with 61.9% female respondents. The sample race/ethnicity was 42.7% non-Hispanic White, 35.4% non-Hispanic Black and 15% Hispanic. Many respondents prefer/strongly prefer viral testing [64.8% for covid, 63.2% for Influenza). 69.2% would isolate and 16.2% would not isolate regardless of the RV test outcome. Only 37 (14.6%) respondents would change their behavior based on the RV test result [5 (2.0%) would not isolate with a positive test but would with a negative test; 32 (12.6%) would isolate only with a positive test]. No demographic variables were significantly associated with behavior change based on RV testing outcome.

Although patients prefer testing for RV, in this sample, RV test results were unlikely to significantly change patients’ planned isolation behavior. These findings add to the literature suggesting that routine ED viral testing has limited benefit.