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 Pathway<ref>https://asprtracie.hhs.gov/technical-resources/119/covid-19-hospital-triage-screening-resources/99</ref>==
==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>


==Protocols==
Consider creating standardized protocols for the following:
*Labs/Imaging
*Intubation
*CPR
*Asthma
*CV procedures
*Disposition
==Surge Capacity==
*Hospital Dependent


==SARS-CoV2 Testing Strategies==
==SARS-CoV2 Testing Strategies==
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==Resource Allocation==
==Resource Allocation==
*Ventilators
 




==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>
 
 


==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 00:30, 9 April 2020

  • All hospital dependant, please check with your hospital administration for existing protocols


Hospital/ED Readiness

  • ASPR Tracie ED Resources [1]
  • PAHO readiness
    • Checklist [2]
    • Instructions [3]
  • MGH Hospital ToolKit [4]
  • ACEP ED Readiness [5]

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

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

Testing+Surveillance: COVID

Telehealth

Resource Allocation

Personnel

  • Exposed Healthcare workers - CDC [13]
  • Return to work for Healthcare providers - CDC [14]
  • Sustaining Healthcare workforce - ASPR [15]
  1. https://asprtracie.hhs.gov/technical-resources/123/covid-19-emncy-department-resources/99
  2. 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
  3. 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
  4. https://www.massgeneral.org/assets/MGH/pdf/disaster-medicine/SARS-CoV-2%20(COVID-19)%20Toolkit%20Version%203.pdf (2)
  5. https://www.acep.org/globalassets/sites/acep/media/by-medical-focus/covid-19-national-strategic-plan_0320.pdf
  6. https://asprtracie.hhs.gov/technical-resources/119/covid-19-hospital-triage-screening-resources/99
  7. 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.
  8. 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.
  9. https://www.health.mil/Reference-Center/Technical-Documents/2020/03/24/DoD-COVID-19-Practice-Management-Guide
  10. https://asprtracie.hhs.gov/technical-resources/114/covid-19-pre-hospital-emncy-medical-services-ems-resources/99
  11. https://asprtracie.hhs.gov/technical-resources/119/covid-19-hospital-triage-screening-resources/99
  12. https://asprtracie.hhs.gov/technical-resources/113/covid-19-critical-care-surge-resources/99
  13. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
  14. 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
  15. https://asprtracie.hhs.gov/technical-resources/120/covid-19-workforce-protection-sustainability-resources/99