For ALL patients (adults & children) - PowerPoint Presentation

Slide1

For ALL patients (adults & children)

COVID

screening questions, to aid further clinical assessment:

In the

10

days prior to illness onset OR clinical encounter:

Any contact

¹

with a case/cluster of COVID-19, or visit to a location of interest ¹ where they are

NOT

required to self-isolate or stay at home

Exited a MIF/MIQ (

EXCEPT

recovered COVID-19 cases)

Border-facing workers

³

OR healthcare workers in areas that have recently managed COVID positive patients

COVID-19 Exposure*

Black isolation sign

Negative pressure room if confirmed with PCR

Room with door

COVID test

asap and write “

Covid

exposure

”

Manage clinical presentation

Check for symptoms

Discuss with

KidzFirst Paediatrician if <15

COVID-19 Suspected*Black isolation signNegative pressure room once confirmed with PCR.Room with doorCOVID test asap and write “Covid suspected” Send eRef notification to ARPHSDiscuss all cases with ID (or KidzFirst Paediatrician if <15)

Low risk contactStandard PrecautionsCOVID test asap (write “Asymptomatic contact” Manage clinical presentationWeekly COVID testingCheck for symptomseRef not required

Viral symptoms*Orange isolation signPrioritise respiratory to a room with a doorCan cohort with other orange door patientsCOVID test asapNegative pressure room if COVID confirmed on PCRMinor irritating cough for weeks following RTI manage routine

Routine management

Cause unknown or symptoms consistent with viral illness? (Clinical judgement)Abdo pain6 Y / NHeadache6 Y / N

Any current acute symptoms consistent with COVID-19?Common COVID symptoms:Acute respiratory tract infection4 Y / NNew onset anosmia/ageusia5 Y / NLess Common COVID symptomsAcute diarrhoea/vomiting6 Y / NMyalgia 6 Y / NFever6 Y / NAny atypical COVID symptoms:Abdo pain6 Y / NHeadache6 Y / N

EPIDEMIOLOGICAL RISK

SYMPTOMS

Yes

No

Atypical COVID symptoms

with no other likely cause:Abdo pain6 Y / NHeadache6 Y / N

No

No

Yes

Any current acute symptoms consistent with COVID-19?Common COVID symptoms:Acute respiratory tract infection4 Y / NNew onset anosmia/ageusia5 Y / NLess Common COVID symptomsAcute diarrhoea/vomiting6 Y / NMyalgia6 Y / NFever6 Y / N

Any current acute symptoms consistent with COVID-19?Common COVID symptoms:Acute respiratory tract infection4 Y / NNew onset anosmia/ageusia5 Y / NLess Common COVID symptomsAcute diarrhoea/vomiting6 Y / NMyalgia6 Y / NFever6 Y / NAtypical COVID symptoms with no other likely cause:Abdo pain6 Y / NHeadache6 Y / N

Yes

No

Yes

No

Yes

IF SYMPTOMS DEVELOP

IF SYMPTOMS DEVELOP

IF SYMPTOMS DEVELOP

No

Yes

In the

10

days prior to illness onset OR clinical encounter:

Any contact¹ with a case/cluster of COVID-19, or visit to a location of interest¹ where they are required to self-isolate or stay at homeInternational travel that requires a stay in MIQ²

ED staff mandatory N-95 mask and eyewear

COVID-19 ED Clinical Assessment ToolFor latest outbreak updates refer to PAANUI - Clinical Resources For Covid-19

Screener’s Name:

Date: Time:

Yes

No

*De-escalation Tool

Please turn over…

Surname:

First Name:

DOB: NHI:

Mobile contact number:

Vaccination status:

0

- 1 - 2 - 3 Patient masked: YES / NO

Patient symptomatic:

NO

/

YES

days since onset? ____________

NPS completed:

YES

/

NO

why? _______________________________________

Request

RAT:

Y / N

Completed

:

Y /

N

Result

:

-

ve

/

+

ve

Document ID:

 Level 3_ED Clinical Assessment

Tool v.40

Adapted CMH version for ED use only

No:

1

Service:

Emergency Department

Date

:

18/11/2021

De-escalation Tool for Emergency Department

DECISION TO DOWNGRADE COVID STATUS, MUST BE MADE BY ED SMO / MOSS / FELLOW / REGISTRAR

VIRAL SYMPTOMS

Symptoms only (no known

epilink

)

INITIAL STATUS

COVID EXPOSURE

Epi

link only (no symptoms)

COVID SUSPECTED

Epi

link and symptoms

ADVISED CONTINUE BLACK DOOR(Preference room with door, not negative pressure room)

SENIOR DECISION

TEST RESULT

Non-Covid cause of symptoms determined, especially with atypical symptoms such as abdo pain or headache. Name: Date: Time: CLINICAL IMPRESSIONREVIEW ABSENCE OF SYMPTOMS and CONFIRM EXPOSURE Consider vaccination statusONGOING CLINICAL CONCERN FOR COVIDStraight forward cases, do not wait for SARS-CoV-2 PCR surveillance result.

Acute Respiratory Tract Infection (not

Covid)

NOT COVIDOther cause for viral symptoms.Discuss vaccination status if necessary. Call vaccination team, consent and prescription required NEW STATUSPlease circleCOVID EXPOSUREWatch for developing symptoms.Further testing required either as inpatient or in communityCOVID SUSPECTEDFurther testing. Sputum is superior to NPS, and strongly Recommended if pneumonia or productive cough.

ADVISED DROPLET (Yellow door sign)until RTI resolved for 2/7. Minor cough for weeks after RTI, does not require isolation.ADVISED ROUNTINE

Other diagnosisREVIEW ABSENCE OF EPI LINKDisclosure of exposure Timing of NPSConsider alternative diagnosis / chronic respiratory illnessConsider vaccination statusINFECTION CONTROL

SARS-CoV-2 PCR = NEGATIVEED TEAM’S CLINICAL IMPRESSION

Borderline or difficult cases

recommend discuss withCOVID ID SMO<15 years discuss with KidzFirst Paediatrician COVID-19 Exposure*

Black isolation signNegative pressure room if confirmed with PCRRoom with door COVID test asap and write “Covid exposure” Manage clinical presentationCheck for symptomsDiscuss with KidzFirst Paediatrician if <15COVID-19 Suspected*Black isolation signNegative pressure room once confirmed with PCR.Room with doorCOVID test asap and write “Covid suspected” Send eRef notification to ARPHSDiscuss all cases with ID (or KidzFirst Paediatrician if <15)Viral symptoms*Orange isolation signPrioritise respiratory to a room with a door

Can cohort with other orange door patientsCOVID test asap

Negative pressure room if COVID confirmed on PCRMinor irritating cough for weeks following RTI

manage routine