COVID-19: Hospital preparedness: Difference between revisions
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*All hospital dependant, please check with your hospital administration for existing protocols | *All hospital dependant, please check with your hospital administration for existing protocols | ||
==Hospital/ED Readiness== | |||
*ASPR Tracie ED Resources <ref>https://asprtracie.hhs.gov/technical-resources/123/covid-19-emncy-department-resources/99</ref> | |||
*PAHO readiness | |||
**Checklist <ref>https://www.paho.org/hq/index.php?option=com_docman&view=download&alias=51716-hospital-readiness-checklist-for-a-novel-coronavirus-ncov&category_slug=scientific-technical-materials-7990&Itemid=270&lang=en</ref> | |||
**Instructions <ref>https://www.paho.org/hq/index.php?option=com_docman&view=download&alias=51761-hospital-readiness-checklist-for-covid-19&category_slug=scientific-technical-materials-7990&Itemid=270&lang=en</ref> | |||
*MGH Hospital ToolKit <ref>https://www.massgeneral.org/assets/MGH/pdf/disaster-medicine/SARS-CoV-2%20(COVID-19)%20Toolkit%20Version%203.pdf (2)</ref> | |||
*ACEP ED Readiness <ref>https://www.acep.org/globalassets/sites/acep/media/by-medical-focus/covid-19-national-strategic-plan_0320.pdf</ref> | |||
==Hospital Protocols== | |||
*Consider creating standardized protocols for the following: | |||
**Labs/Imaging | |||
**Intubation | |||
**CPR | |||
**Asthma | |||
**CV procedures | |||
**Disposition | |||
*ASPR TRACIE 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 protocols- <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> | |||
*Department of Defense Practice Managment - <ref>https://www.health.mil/Reference-Center/Technical-Documents/2020/03/24/DoD-COVID-19-Practice-Management-Guide</ref> | |||
==Prehospital Care== | ==Prehospital Care== | ||
EMS Resources - ASPR <ref>https://asprtracie.hhs.gov/technical-resources/114/covid-19-pre-hospital-emncy-medical-services-ems-resources/99</ref> | |||
*ET-3 model | *ET-3 model | ||
*Treat Onsite | *Treat Onsite | ||
==Evaluation | ==Evaluation Pathways== | ||
*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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*Control movement between sections by limiting ingress/egress routes. | *Control movement between sections by limiting ingress/egress routes. | ||
*Consider having all patients wear surgical masks and perform hand hygiene despite symptoms. | *Consider having all patients wear surgical masks and perform hand hygiene despite symptoms. | ||
===Screening=== | ===Screening<ref>https://asprtracie.hhs.gov/technical-resources/119/covid-19-hospital-triage-screening-resources/99</ref>=== | ||
*Preferably outside of the ER | *Preferably outside of the ER | ||
*Goal is to prevent them from being cohorted with non-COVID patients | *Goal is to prevent them from being cohorted with non-COVID patients | ||
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*Severe illness - Admission | *Severe illness - Admission | ||
==Surge Capacity== | |||
*ASPR TRACIE Surge resources <ref>https://asprtracie.hhs.gov/technical-resources/113/covid-19-critical-care-surge-resources/99</ref> | |||
==SARS-CoV2 Testing Strategies== | ==SARS-CoV2 Testing Strategies== | ||
Line 70: | Line 86: | ||
==Resource Allocation== | ==Resource Allocation== | ||
==Personnel== | ==Personnel== | ||
*Return to work | *Exposed Healthcare workers - CDC <ref>https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html</ref> | ||
*Return to work for Healthcare providers - CDC <ref>https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhealthcare-facilities%2Fhcp-return-work.html</ref> | |||
*Sustaining Healthcare workforce - ASPR <ref>https://asprtracie.hhs.gov/technical-resources/120/covid-19-workforce-protection-sustainability-resources/99</ref> | |||
[[Category:COVID-19]] | [[Category:COVID-19]] |
Revision as of 00:30, 9 April 2020
- All hospital dependant, please check with your hospital administration for existing protocols
Hospital/ED Readiness
Hospital Protocols
- Consider creating standardized protocols for the following:
- Labs/Imaging
- Intubation
- CPR
- Asthma
- CV procedures
- Disposition
- ASPR TRACIE COVID-19 Hospital Triage/Screening Resources [6]
- Brigham & Women's Hospital Protocols- [7]
- Massachusets General Hospital protocols- [8]
- Department of Defense Practice Managment - [9]
Prehospital Care
EMS Resources - ASPR [10]
- ET-3 model
- Treat Onsite
Evaluation Pathways
- 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[11]
- 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
Surge Capacity
- ASPR TRACIE Surge resources [12]
SARS-CoV2 Testing Strategies
Telehealth
- For information on telehealth, see Alternative Care Sites: COVID-19
Resource Allocation
Personnel
- Exposed Healthcare workers - CDC [13]
- Return to work for Healthcare providers - CDC [14]
- Sustaining Healthcare workforce - ASPR [15]
- ↑ https://asprtracie.hhs.gov/technical-resources/123/covid-19-emncy-department-resources/99
- ↑ https://www.paho.org/hq/index.php?option=com_docman&view=download&alias=51716-hospital-readiness-checklist-for-a-novel-coronavirus-ncov&category_slug=scientific-technical-materials-7990&Itemid=270&lang=en
- ↑ https://www.paho.org/hq/index.php?option=com_docman&view=download&alias=51761-hospital-readiness-checklist-for-covid-19&category_slug=scientific-technical-materials-7990&Itemid=270&lang=en
- ↑ https://www.massgeneral.org/assets/MGH/pdf/disaster-medicine/SARS-CoV-2%20(COVID-19)%20Toolkit%20Version%203.pdf (2)
- ↑ https://www.acep.org/globalassets/sites/acep/media/by-medical-focus/covid-19-national-strategic-plan_0320.pdf
- ↑ 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
- ↑ https://asprtracie.hhs.gov/technical-resources/114/covid-19-pre-hospital-emncy-medical-services-ems-resources/99
- ↑ https://asprtracie.hhs.gov/technical-resources/119/covid-19-hospital-triage-screening-resources/99
- ↑ https://asprtracie.hhs.gov/technical-resources/113/covid-19-critical-care-surge-resources/99
- ↑ https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
- ↑ https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhealthcare-facilities%2Fhcp-return-work.html
- ↑ https://asprtracie.hhs.gov/technical-resources/120/covid-19-workforce-protection-sustainability-resources/99