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Recent studies have suggested different organisational strategies, modifying Emergency Departments (EDs) during the COVID-19 epidemic. However, real data on the practical application of these strategies are not yet available. The objective of this study is to evaluate the inclusion of pre-triage during the COVID-19 outbreak. In March 2020, the structure of the ED at Merano General Hospital (Italy) was modified, with the introduction of a pre-triage protocol to divide patients according to the risk of infection. The performance of pre-triage was evaluated for sensitivity, specificity and negative predictive value (NPV). From 4th to 31st March, 2,279 patients were successively evaluated at the pre-triage stage. Of these, 257 were discharged directly from pre-triage by triage out or home quarantine and none has subsequently been hospitalised. Of the 2022 patients admitted to ED, 182 were allocated to an infected area and 1840 to a clean area. The proportion of patients who tested COVID-19 positive was 5% and, of these, 91.1% were allocated to the infected area. The pre-triage protocol demonstrated sensitivity of 91.1%, specificity of 95.3% and NPV of 99.5%. In addition, none of the healthcare workers was infected during the study period. Pre-triage can be a useful tool that, if standardised and associated with a change in the structure of the ED, can limit the spread of infection within the ED, optimise ED resources and protect healthcare workers.