COVID-19: Hospital preparedness: Difference between revisions
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''All protocols are hospital dependent, please check with your hospital administration for existing protocols'' | |||
==Hospital/ED Readiness== | |||
''See [[COVID-19: Example hospital protocols]] for example hospital protocols from various institutions.'' | |||
*Resources | |||
**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> | |||
==Prehospital Care== | ==Prehospital Care== | ||
*ET-3 model | *ET-3 model | ||
*Treat Onsite | *Treat Onsite | ||
*Resources | |||
**EMS Resources - ASPR <ref>https://asprtracie.hhs.gov/technical-resources/114/covid-19-pre-hospital-emncy-medical-services-ems-resources/99</ref> | |||
==Screening/ | ==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 [[Prevention of COVID-19 transmission in the healthcare setting|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<ref>https://asprtracie.hhs.gov/technical-resources/119/covid-19-hospital-triage-screening-resources/99</ref>=== | |||
*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 | |||
**Exposure to COVID patient recently with symptoms | |||
**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 + [[Template:COVID Risk Factors|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== | ==Surge Capacity== | ||
*ASPR TRACIE Surge resources <ref>https://asprtracie.hhs.gov/technical-resources/113/covid-19-critical-care-surge-resources/99</ref> | |||
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==Resource Allocation== | ==Resource Allocation== | ||
==Personnel== | |||
*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> | |||
==See Also== | |||
{{Special:Prefixindex/COVID-19 |hideredirects=1}} | |||
==References== | |||
[[Category:COVID-19]] | [[Category:COVID-19]] |
Revision as of 03:09, 9 October 2020
All protocols are hospital dependent, please check with your hospital administration for existing protocols
Hospital/ED Readiness
See COVID-19: Example hospital protocols for example hospital protocols from various institutions.
- Resources
Prehospital Care
- ET-3 model
- Treat Onsite
- Resources
- EMS Resources - ASPR [6]
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[7]
- 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
- Exposure to COVID patient recently with symptoms
- 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 [8]
SARS-CoV2 Testing Strategies
Telehealth
- For information on telehealth, see Alternative Care Sites: COVID-19
Resource Allocation
Personnel
- Exposed Healthcare workers - CDC [9]
- Return to work for Healthcare providers - CDC [10]
- Sustaining Healthcare workforce - ASPR [11]
See Also
References
- ↑ 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/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