COVID-19: Hospital preparedness: Difference between revisions
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*Treat Onsite | *Treat Onsite | ||
==Evaluation Pathway== | ==Evaluation Pathway<ref>https://asprtracie.hhs.gov/technical-resources/119/covid-19-hospital-triage-screening-resources/99</ref>== | ||
*Divide the ED into different sections based on risk of having/transmitting COVID-19 | *Divide the ED into different sections based on risk of having/transmitting COVID-19 | ||
**Red/Dirty/Hot zone | **Red/Dirty/Hot zone | ||
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***Re-evaluate for discharge if improved | ***Re-evaluate for discharge if improved | ||
*Severe illness - Admission | *Severe illness - Admission | ||
==Protocols== | ==Protocols== | ||
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==Personnel== | ==Personnel== | ||
*Return to work | *Return to work | ||
==Resources== | |||
===Examples=== | |||
*Topic Collection: COVID-19 Hospital Triage/Screening Resources <ref>https://asprtracie.hhs.gov/technical-resources/119/covid-19-hospital-triage-screening-resources/99</ref> | |||
*Brigham & Women's Hospital Protocols- <ref>COVID-19 Protocols. Brigham and Women’s Hospital COVID-19 Clinical Guidelines. https://covidprotocols.org/protocols/02-ed-inpatient-floor-management-triage-transfers. Published 2020. Accessed April 8, 2020.</ref> | |||
*Massachusets General Hospital - <ref>Massachusetts General Hospital COVID-19 Treatment Guide Version 1.36 04/05/2020. https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/mass-general-COVID-19-treatment-guidance.pdf. Published 2020. Accessed April 8, 2020.</ref> | |||
*Mount Sinai - | |||
[[File:MSH covid Management|thumb]] | |||
*Department of Defense Practice Managment - <ref>https://www.health.mil/Reference-Center/Technical-Documents/2020/03/24/DoD-COVID-19-Practice-Management-Guide</ref> | |||
[[Category:COVID-19]] | [[Category:COVID-19]] | ||
Revision as of 23:52, 8 April 2020
- All hospital dependant, please check with your hospital administration for existing protocols
Prehospital Care
- ET-3 model
- Treat Onsite
Evaluation Pathway[1]
- Divide the ED into different sections based on risk of having/transmitting COVID-19
- Red/Dirty/Hot zone
- Yellow/Intermediate/cool zone (optional)
- Green/Clean/Cold zone
- Set PPE levels for each section IPC for COVID
- Control movement between sections by limiting ingress/egress routes.
- Consider having all patients wear surgical masks and perform hand hygiene despite symptoms.
Screening
- Preferably outside of the ER
- Goal is to prevent them from being cohorted with non-COVID patients
- Funnel into each of your zones
- Screening Criteria - Any of the following positive, route to "red/dirty/hot/infected" side of the ED
- Symptoms - fever, respiratory symptoms, Chest pain, GI symptoms, malaise, fatigue
- Signs
- toxic appearance, AMS
- If performing vitals at screening - fever, hypoxia, tachypnea
- All those without the above go to Yellow/Green
Triage/Risk Stratification
- Mild illness
- Well appearing
- No hypoxia (SPO2 ≥94%)
- No tachypnea (RR≥22)
- No concerning GI or Other symptoms
- Moderate/Severe illness
- Hypoxia
- Tachypnea
- Ill-appearing + COVID Risk Factors
- Other reasons needing admission
Evaluation for Disposition
- Mild illness
- Discharge as appropriate
- Consider Exertional O2Sat
- 1 minute walking in place briskly.
- Failure = 02Sat<90 OR inability to complete test
- Moderate illness
- 02 via NC Sat>90%
- Attempt bronchodilator use
- Antipyretics
- CXR
- Evaluate for non-COVID causes of illness as indicated
- Re-evaluate for discharge if improved
- Severe illness - Admission
Protocols
Consider creating standardized protocols for the following:
- Labs/Imaging
- Intubation
- CPR
- Asthma
- CV procedures
- Disposition
Surge Capacity
- Hospital Dependent
SARS-CoV2 Testing Strategies
Telehealth
- For information on telehealth, see Alternative Care Sites: COVID-19
Resource Allocation
- Ventilators
Personnel
- Return to work
Resources
Examples
- Topic Collection: COVID-19 Hospital Triage/Screening Resources [2]
- Brigham & Women's Hospital Protocols- [3]
- Massachusets General Hospital - [4]
- Mount Sinai -
- Department of Defense Practice Managment - [5]
- ↑ https://asprtracie.hhs.gov/technical-resources/119/covid-19-hospital-triage-screening-resources/99
- ↑ https://asprtracie.hhs.gov/technical-resources/119/covid-19-hospital-triage-screening-resources/99
- ↑ COVID-19 Protocols. Brigham and Women’s Hospital COVID-19 Clinical Guidelines. https://covidprotocols.org/protocols/02-ed-inpatient-floor-management-triage-transfers. Published 2020. Accessed April 8, 2020.
- ↑ Massachusetts General Hospital COVID-19 Treatment Guide Version 1.36 04/05/2020. https://www.massgeneral.org/assets/MGH/pdf/news/coronavirus/mass-general-COVID-19-treatment-guidance.pdf. Published 2020. Accessed April 8, 2020.
- ↑ https://www.health.mil/Reference-Center/Technical-Documents/2020/03/24/DoD-COVID-19-Practice-Management-Guide