Admission & Flo · Where possible, single and negative pressure rooms should be available. Ideally,...
Transcript of Admission & Flo · Where possible, single and negative pressure rooms should be available. Ideally,...
Admission & FlowCOVID-19
April 2020
Intended Audience● Clinical staff
Learning Outcomes
This training is designed to highlight points that need to be
considered and put in place when suspected or confirmed COVID
patients present for triage or admission.
By the end of this learning package, you should know:
● How to screen patients for COVID-19 on admission
● How to set up a safe clinical environment/unit to treat COVID-
19 patients
Intended Audience & Learning Outcomes
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1. Patient Screening for COVID-19
Regardless of the
method of admission
every person entering
the hospital MUST be
screened for COVID-19
● This involves the patient answering the questions on the COVID-19 Patient Screening
Questionnaire and the measuring of body temperature.
● The COVID-19 Patient Screening Questionnaire is constantly being updated based
on the most recent government health information.
● The questionnaire identifies if patients are suspected of having COVID-19 and if they
need testing.
● If a patient is suspected COVID-19, then a mask is put on the patient and precautions
are put in place.
● This document may vary slightly between states due to the local outbreak alerts that
need to be considered.
● Staff, visitors or other people who are identified as at risk for COVID-19 will not be
permitted to enter the hospital. These persons need to self isolate as per government
guidelines and seek medical advice.
Screening on admission / entry to hospital
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The most recent Patient Screening Questionnaire is located on the Healthscope Intranet: HINT/Policies & Procedures/COVID-19
There are a number of
ways that a COVID-19
patient can be identified
Flowcharts and pathways
have been set up for each
of these types of
admissions.
● Existing Patients: Some patients have already been screened as safe, admitted, are in the incubation period for
COVID-19 and are unaware. These patients may later develop symptoms.
Any current inpatient that shows fever or respiratory symptoms will have the Screening Questionnaire
applied again.
This could occur for medical, surgical, obstetric, rehabilitation or mental health patients.
If a current inpatient develops the signs and symptoms of COVID-19 they should be isolated in a single
room and a COVID-19 swab MUST be taken. Droplet and contact precautions should be initiated. If
the patient is actively coughing, airborne precautions are to be included as well. Ensure a PPE station
is set up outside the patient room.
● Emergency Department: A number of Healthscope hospitals have Emergency Departments and all have the ability
to test patients. If the hospital is a designated receiving hospital for COVID-19 patients, then an area within the ED
may be set up for patients as they await testing. Alternatively a ward, or area in a ward will be designated for those
patients awaiting swab results. Patients not requiring admission will be sent home to await results.
● COVID-19 Admissions: In some cases, a hospital may receive a direct admission of a patient/s with COVID-19,
direct to a designated Respiratory or Intensive Care Unit.
● Surgical Admissions: If a known COVID-19 patient with mild symptoms requires urgent admission or surgery (eg:
appendicectomy) then these patients may be admitted. Processes for managing the COVID-19 positive patient in the
operating theatre will be initiated.
● Obstetric Admissions: All obstetric patients MUST be screened for COVID-19 pre admission and again upon
admission. Protocols to either admit or transfer the patient will be initiated prior to delivery if the patient is a high risk
of COVID-19 based on their presenting symptoms.
Which patients are screened?
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Flowcharts and pathways are available on the Healthscope Intranet: HINT/Policies & Procedures/COVID-19
All patients presenting to triage MUST be
screened for Covid 19. Any patient presenting
with respiratory symptoms should be considered
as a potential COVID-19 patient until
determined otherwise.
All patients at triage presenting with
respiratory symptoms must put on a surgical
mask. This mask must remain in place until
staff are able to don all necessary PPE and
the patient is placed in the designated
COVID-19 area.
All patients with respiratory disease/failure
are to be immediately placed in the
designated COVID-19 area (ideally a single
room) with droplet and contact transmission
based precautions immediately established.
All patients with respiratory
disease/failure are to swabbed for
COVID-19 on admission.
Once swabbed patients should be moved to
the dedicated COVID-19 ward or other
appropriate designated area to await swab
results.
Emergency Departments: Triage Desk
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● Each Healthscope Emergency Department has a well
established plan and processes to ensure they are prepared
to triage COVID-19 patients.
● Environmental layout, zoning and cleaning, patient flow and
cohorting, infection control requirements, preparation and
separation of clinical treatment spaces, patient assessment
and care requirements and staff safety are all important
aspects that are considered and planned for.
● Most patients who present with COVID-19 symptoms, but
are not acutely unwell, can be tested in the ED and then wait
in home isolation for the test results.
● In some cases, patients with suspected COVID-19 may be
transferred from the ED to a designated COVID-19 receiving
hospital (pubic or private) rather than being admitted.
● In other cases, patients will be admitted to a Respiratory Unit
or Fever Clinic while awaiting their test results
● The Australasian College for Emergency
Medicine provides some very clear
guidance of this in their Clinical
Guidelines for the management of
COVID 19 in Australasian emergency
departments text v1.0 March 2020
Receiving COVID-19 patients in the ED
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● A new Disaster Code of ‘COVID-19’
has been added into webPAS at all
Healthscope & ACHA Hospitals to assist
with the reporting and management of
COVID-19. This will allow appropriate
Emergency and Admitted patients to
be assigned to this code as required.
● Any patient suspected of COVID-19 must
have COVID-19 listed as their presenting
complaint in the Webpas Triage screen.
● COVID 19 also needs to be recorded in
the free type triage comment box, along
with additional information relating to the
presenting complaint.
Triage documentation
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ED Registration
● Select ‘COVID-19’ in the ‘Disaster Code’ field at bottom right
of the registration screen to link the patient to the disaster.
● Disaster Identification # should be left blank if the results are
unknown or type ‘NEGATIVE’ or ‘POSITIVE’ if the status is known.
Triage documentation
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2. Setting up a COVID-19 Unit
In many Healthscope hospitals, a COVID-19 ward will not be required, as these hospitals are not intending to treat large
numbers of patients with the virus.
ALL Healthscope hospitals are prepared to care for a COVID-19 suspected or confirmed patient if required, within a
single room.
● All SUSPECTED cases of COVID-19 are to have the same precautions as confirmed cases, until test results are returned.
● This is NO DIFFERENT to managing any patient on droplet and contact precautions, eg: influenza, whooping cough,
bacterial meningitis.
● If there is one patient on these precautions within the hospital, this will be managed within a single room, with clear signage
and provision for donning and doffing PPE.
● Even if your hospital is not planning to treat COVID-19 patients, you need to be prepared, in case a patient cannot be
transferred out.
SOME Healthscope hospitals are planning for treatment of more cases, if required.
● In this circumstance, a pod (4 bed area) or ward will be designated as the COVID-19 Unit.
● Patients awaiting test results (suspected cases) must be kept separate from confirmed cases of COVID-19.
● Some Healthscope hospitals also have plans for a larger surge, where more than one ward may treat COVID-19 patients.
With the success of social distancing in the Australian community, this will hopefully not be required.
Single Isolation Room vs Unit/Ward Set-up
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COVID-19 wards, units or
pods should be set up to
localize patients to a specific
geographical area and
minimise exposure of staff and
other patients to COVID-19.
Each Hospital Executive team
has developed detailed
Operational Readiness
Plans and checklists to guide
this set up if required.
This requires the development
of a trained workforce and the
design of functional patient and
work flow patterns to support the
implementation of an effective
isolation unit/ward.
To reduce the spread of
COVID-19 to other patients
and to healthcare workers,
patients should be cohorted
where possible into dedicated
isolation pods, units or wards
or transferred to hospitals
where isolation is possible.
Setting up the environment
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Dedicated COVID-19 wards, units or pods should be
set-up to minimise exposure
● Provide clear signage as to preferred patient flow routes and what routes
are restricted – e.g. ‘clean’ routes for staff and visitors should ideally be
available that patients are not being moved through
● If appropriate, Hot, Warm, Cold zones can be established, depending
on the size of the ward/unit (refer separate guidelines).
● Patient flow routes should avoid contamination of PPE.
● Clean routes should avoid exposure to areas where testing and aerosol
generating procedures (AGPs) may be performed .
● All those entering the unit must be signed in, including staff and visitors.
● An Entry / Exit should also be clearly marked, with space for individuals
to donning & doffing PPE.
Designating areas
A dedicated ward/pod should be
identified to care for suspected
COVID-19 patients.
It is preferable that isolation wards /
areas have a separate entrance or
can be segregated from the rest of
the hospital to minimize unnecessary
foot traffic through the isolation ward /
area.
For more information, refer to
guidelines for COVID-19 Ward/Unit
Setup on the Healthscope intranet.
Setting up the environment
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Where possible, patients should be physically separated between
those that are confirmed, suspected and awaiting testing.
Only confirmed COVID19 positive patients should housed together.
Where rooms are shared:
● Only confirmed COVID-19 patients should be housed together
● Suspected COVID-19 patients cannot share rooms
● Beds must be spaced at least 1.5 metres apart and the curtains
drawn.
Where possible, single and negative pressure
rooms should be used.
Setting up the environment
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Setting up the environment
Designating areas
A dedicated ward/pod should be
identified to care for suspected
COVID-19 patients.
It is preferable that isolation wards /
areas have a separate entrance or
can be segregated from the rest of
the hospital to minimize
unnecessary foot traffic through the
isolation ward / area. In some
hospitals this may be challenging but
characteristics in the COVID-19:
Principles of COVID-19 ward/unit
setup guidelines should be reviewed
and followed.
Characteristics of selected
potential COVID-19
wards/pods
Ideal characteristics of wards/pods
selected should include the capacity
to care for critically ill patients:
● Two oxygen outlets
● One air outlets
● Two suction outlets
● Twelve mains electricity outlets
● Appropriate physiological
monitoring
● Negative pressure rooms (2)
Next stepsCOVID-19 Principles of
COVID-19 ward/unit setup
are available on the Intranet
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Setting up the environment
Set up of COVID ward / Pods
Where possible, single and negative pressure rooms
should be available.
Ideally, any AGPs should be performed in a negative
pressure room. If negative pressure rooms are not
available, single rooms are sufficient.
Where rooms are shared, beds must be spaced at
least 1.5 metres apart, preferably more to allow for
space for healthcare workers.
Where rooms are shared, only confirmed COVID-19
positive patients should housed together
Patients who are suspected of COVID-19 and
awaiting COVID-19 PCR testing results should
be in single rooms to avoid the risk of cross infection.
Where possible, separate pods/areas should be
established for patients with suspected COVID-19 and
those with confirmed COVID-19.
There should be a clearly marked single entrance
and exit with a PPE station for staff and other
essential visitors to hand wash, sign in and don PPE
when entering
the unit.
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Establishing a COVID-19 On-Call Roster
It is critical to involve site VMOs in the set up of a
COVID-19 ward.
A COVID-19 VMO roster should be established as
soon as the need for the COVID-19 ward is initiated.
Respiratory, General Medicine and Infectious Diseases
Physician’s are appropriate to service the roster.
Respiratory, General Medicine and Infectious Diseases
Physicians are likely to be involved in the COVID-19
wards in the public sector and will have an on call
component to these appointments as well.
If the VMO is on call for the COVID-19 ward in the
public sector they cannot be on call for the COVID-19
ward in the private sector due to the risk of transfer of
disease.
You will need to work with your VMOs to establish the
best way to form a roster. The VMOs on the roster will
be the only doctors who enter and treat patients on the
COVID-19 ward.
The COVID-19 on-call VMO will liaise with the primary
specialty and co-ordinate care until the patient’s
COVID-19 status is known. If negative, the patient will
be transferred to a suitable ward and the care of the
primary specialist. If positive, the patient is admitted to
the appropriate COVID-19 positive ward and remains
cared for by the COVID-19 doctor with that doctor
liaising with any other specialist required to co-ordinate
the ongoing care of the patient.
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● Only minimal supplies
should be stored within the
COVID-19 patient room.
This includes patient care
supplies, medical supplies
and linen etc.
● Trolleys with equipment or
supplies should be collected as
needed and placed outside the
patient area.
● A buddy or runner, who is
positioned outside the patient
area, can pass over any required
equipment or supplies as they
are needed. This is critical to
ensure minimal wastage of
all supplies.
● Any supplies that are within
the patient environment
must be disposed of or
reprocessed if they are
removed from the room or
at the time the room is
terminally cleaned.
Supplies in the patient room
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Equipment in patient rooms
● If it does not impede normal operating, equipment in a COVID-19 patient’s room
can be covered with clear plastic. The equipment can then be viewed and
operated through the plastic with only the connecting cabling extending out from
under the plastic.
● For all electrical equipment it is important to ensure sufficient airflow under
any plastic drape.
● When equipment is removed from within the patient environment, or the patient
is discharged from the room, the plastic can be removed and discarded.
● The equipment is then cleaned as per manufacturer’s guidelines. Full droplet
and contact precaution PPE is to be worn during the cleaning process.
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3. Keeping yourself safe
Physical distancing and
hand hygiene
Maintain physical distancing and hand
hygiene are key COVID-19 safety
strategies and they must be applied at all
times.
Face masks
All staff working in high risk areas are
required to wear (at a minimum)
surgical face masks for the duration of
the shift. This includes Emergency
Departments, Intensive Care Units
and Respiratory Units.
Donning and doffing buddy
It is a requirement that staff have a
donning and doffing buddy present
when undertaking any PPE donning
and doffing procedures.
Keeping yourself safe
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Scrubs and work uniforms
● Scrub use in interventional suites, operating
theatres and delivery suite continues
as normal.
● No personal scrubs are to be worn.
● Scrubs must not leave the hospital and must
be laundered by the hospital laundry service.
● Staff wearing uniform should, where possible,
change into and out of uniform on site. Where
this is not possible, staff are advised to go
directly home at the end of their shift to
launder any items worn at work.
● Guidelines about management of scrubs
and work uniform are located on the COVID-
19 intranet site and are updated regularly.
Depending on individual site risk
assessments, hospitals should
work towards a system where
wearing of scrubs occurs in:
● Emergency Departments
● ICU
● Respiratory Units
● Staff treating suspected or
confirmed COVID-19 patients
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PPE stations
• For areas where there are a number of patients, with staff
wearing full PPE in the patient zones as well as shared zones,
then the PPE station is set up at the entrance to this area.
• If PPE is only required in the specific patient zones, and not in
the shared zones, then the PPE station should be at the
entrance to the patient zone.
The location of PPE stations will be dependent
on the set up of the COVID-19 area.
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Following this learning module,
you should now understand
how to:
● How to screen patients for COVID-19 on
admission
● How to set up the environment to treat
COVID-19 patients
Next steps
● Complete other learning modules,
relevant to your role.
● Visit HINT for more information.
● Speak with your Unit Manager/Team
Leader if you have any concerns
or would like further information.
Next steps
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