What is your flu process?

The way ours is supposed to work is: if a patient is febrile with respiratory symptoms when they come to the ED, they are swabbed and placed on droplet precautions and this is communicated to the floor. But what keeps happening is they aren't swabbed and the symptoms aren't even noted in report, and we put the patient in with another patient, note the telltale signs upon arrival and place on precautions and swab them. But we've already exposed another patient and some staff because we were told no precautions. Then of course the swab comes back positive.

Had this happen this weekend: ED sends up a patient with a diagnosis of "cellulitis." The most non-cellulitis cellulitis I'd ever seen. They were blaming her fever on that and declined to mention any respiratory symptoms. Said no precautions. Didn't swab her. Comes up with a pouring nose, sore throat, hacking cough. I immediately swab her and put her on precautions. But she'd already been put in a room with another patient and exposed our staff. Came back positive of course and they shipped her off to another floor.

So just curious what your process is both in theory and in practice and how well it is working to prevent the exposure and spread of flu?