Objectives: COVID-19 started spreading widely in China. Outpatient fever clinics (FC),were upgraded to serve for COVID-19 screening and prevention of disease transmission in large tertiary hospitals in China. We aimed to evaluate the effect of upgrading the FC system on rates of nosocomial COVID-19 infection and ED patient attendance at PUMCH Methods: The FC of PUMCH was upgraded on January 20, 2020. We performed a retrospective study of patients presenting to the FC between December 12, 2019 and February 29, 2020. January 20, 2020 was the date when COVID-19 was declared an outbreak in Beijing. Two groups of data were collected and subsequently compared with each other: The first group of data was collected within 40 days before January 20, 2020; The second group of data was collected within 40 days after January 20, 2020. All necessary data, including patient baseline information, diagnosis, follow-up conditions, and the transfer records between the FC and ED were collected and analyzed. Results: 6,365 patients were screened in the FC, among whom 2,912 patients were screened before January 21, 2020, while 3,453 were screened afterward. Screening results showed that upper respiratory infection was the major disease associated with fever. After the outbreak of COVID-19, the number of patients who were transferred from the FC to ED decreased significantly [39.21% vs 15.75%, p<0.001], and patients generally spent more time in the FC [55 vs 203minutes, p, compared with before the outbreak. For critically ill patients waiting for their screening results, the total length of stay in the FC was 22minutes before the outbreak, compared with 442minutes after the outbreak Conclusion: The workload of the FC increased significantly after the COVID-19 outbreak. New protocols regarding the use of FC likely helped prevent the spread of COVID-19 l. The upgraded FC reduce the burden on the ED

The FC of PUMCH was upgraded on January 20, 2020. We performed a retrospective study of patients presenting to the FC between December 12, 2019 and February 29, 2020. January 20, 2020 was the date when COVID-19 was declared an outbreak in Beijing. Two groups of data were collected and subsequently compared with each other: The first group of data was collected within 40 days before January 20, 2020; The second group of data was collected within 40 days after January 20, 2020. All necessary data, including patient baseline information, diagnosis, follow-up conditions, and the transfer records between the FC and ED were collected and analyzed.We collected data from all patients presenting to the FC of PUMCH in the last 40 days before the FC upgrade (from December 12, 2019 to January 20, 2020), and for another 40 days after FC upgrade (from January 21 to February 29, 2020). The FC was upgraded on January 20, 2020 which was also the official date when COVID-19 was declared an “outbreak” in Beijing. We included all critically ill patients during the period of this study, who initially presented to the FC and subsequently transferred to the ED The data were collected from patients’ medical records and their registration information. Clinical manifestation, primary diagnosis, time of registration, and the duration of each consultation were documented for all patients involved in the study.

Critically ill patients were included based on the following criteria: (1) patients who were transferred to the resuscitation room in the ED after initial screening and treatment at the FC; (2) APACHE II score ≥8; (3) patients who tested negative for COVID-19^[11]. Critically ill patients’ prognosis and treatment results were documented in their medical records. Changes in patients’ condition (e.g. improvement, deterioration or death) within seven days after their initial presentation at the FC were also recorded.

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