COVID-19: Hospital preparedness
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All protocols are hospital dependent, please check with your hospital administration for existing protocols
Contents
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
- 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