SCGH Specific Guidelines
SCGH ED COVID-19 Guidelines
- SCGH ED COVID Response Video, & other, Updates:
- Charlie’s COVID Chronicles #7 – 27th May 2020 – The ED Escalation Plan
- Charlie’s COVID Chronicles #6 – 22nd May 2020 – The Triage Sieve
- Charlie’s COVID Chronicles #5 – 6th May 2020 – Dr Rippey clarifies the Mx of Out of Hospital Cardiac Arrest (OOHCA) patients at SCGH ED during the COVID pandemic
- Charlies COVID Chronicles #4 – 23rd April 2020 – updates on current COVID issues, main department flows, Obs ward flow, new green LG Obs ward flow, MET calls in green Obs ward and COVID escalation planning
- My Charlie’s Stay – a letter for all Charlie’s staff from Dr James Rippey
- Charlie’s COVID Chronicles #3 – 5th April 2020 – updates: imaging guidelines, respiratory procedure risk management, APO / COPD / asthma / CPR Mx in COVID era, ENT & Ophthalmology patient Mx, intubating the COVID patient, ventilator settings in COVID, transport procedures for the COVID patient, patient discharge advice and staff wellbeing!
- Charlie’s COVID Chronicles #2 – 31st March 2020 – updates: initial assessment tools for COVID patients (developed by Lynda Vine), writing notes on Word and EDIS (Rippey /Hay) which replaces the notes chapter in CCC#1
- Charlie’s COVID Chronicles #1 – 27th March 2020 update from Dr James Rippey – with thanks to Tor Ercleve, Nicole Hoskins, Nick Martin, Susie Mills and Megan Rayner (password protected – see your emails)
- Triage:
- Triage screening questions – to categorise patients – any queries see ED COVID Triage Sieve #2 (low community spread) (from 30/01/2021) and and call Duty Consultant (x77255)
- Triage Patient Placement for Initial Assessment
- ILI / Respiratory Sx’s – into Triage Lobby for initial assessment, then either Home / COVID Clinic / Orange or Red designated area in the ED
- Non-ILI / Respiratory Sx’s – into main ED WR / FT WR / Green Resus or Green Assessment Bed / Green OBS
- ED Patient Placement:
- ED COVID Triage Sieve #2 (low community spread) = Situation from 30/01/2021
- ED COVID Escalation Plans – All Levels (0-6) (internal)
- Where do different categories of patients get placed within the department at different levels of community COVID prevalence / departmental load – see “trigger to escalate” in document
- ED COVID Escalation Plan Level 0 (internal)
- ED COVID Escalation Plan Level 1 (internal) – Current state as of 30/01/2021
- ED COVID Escalation Plan Level 2 (internal)
- ED COVID Escalation Plan Level 3 (internal)
- ED COVID Escalation Plan Level 4 (internal)
- ED COVID Escalation Plan Level 5 (internal)
- ED COVID Escalation Plan Level 6 (internal)
- Where do different categories of patients get placed within the department at different levels of community COVID prevalence / departmental load – see “trigger to escalate” in document
- Historical Community COVID Prevalence Plans:
- ED COVID Triage Sieve #0 (no community spread) = Situation from 22/06/2020 – 30/01/2021
- ED COVID Triage Sieve #1 (no community spread) = Situation as of 27/05/2020 – 22/06/2020
- ED COVID Triage Sieve #2 (low community spread) = Situation from 30/01/2021
- COVID Testing Criteria
- WA COVID Clinic Testing Guidelines, OR
- WA Health Care Worker Testing Guidelines (as per latest SitRep – internal),
- “any healthcare worker with direct patient contact has a fever (≥38°C), or history of fever (eg. night sweats, chills) AND an acute respiratory infection (e.g. shortness of breath, cough, sore throat)” – as of 24/03/2020, OR
- If outside testing criteria AND high clinical suspicion for an admitted patient, then d/w COVID Consultant x74611 (consultant to consultant in hours)
- Imaging Pathways:
- Radiology:
- Imaging ED Patients during the COVID Pandemic Guideline
- COVID Risk Assessment Stamp – for imaging requests
- Critical Care Ultrasound in COVID
- Lung Ultrasound Report
- Instructional Video of Lung Ultrasound in COVID Patients – by Dr James Rippey
- Lung Ultrasound: COVID-19 Cases – by Dr James Rippey via LITFL
- Cleaning the Ultrasound Machine – see: WA DOH – Coronavirus Disease-19 (COVID-19) Infection Prevention and Control in the Hospital Setting
- Probe cover when possible
- Clinell wipes (single-step detergent and disinfectant wipe) as a single wipe OR Tuffee wipes (detergent wipe) followed by Alcohol-based (disinfectant) wipes
- Radiology:
- COVID Patient Admission Communication:
- Call COVID Consultant via x74611
- Booking Slip under Dr Kosky, Respiratory Medicine
- COVID Assessment Team (COAT) Rounds (Resp / ICU / Anaesthetics) start ~11:30 arrive in ED ~12:00 to meet ED Duty Consultant
- SCGH ED Management Guidelines for:
- Acute Respiratory Conditions +/- COVID:
- Respiratory Procedures HCW Transmission – Video explanation by Dr Celenza (password protected)
- Acute Pulmonary Oedema (APO) +/- COVID Mx
- Chronic Obstructive Pulmonary Disease (COP) +/- COVID Mx
- Asthma +/- COVID Mx
- Cardiopulmonary Resuscitation (CPR) / Modified ALS Algorithm during COVID Pandemic v2.4 (1/2021)
- Video explanation of version 2.0: The SCGH ED Modified ALS Algorithm During the COVID-19 Pandemic Response – by Dr Nick Martin
- Acute Respiratory Conditions +/- COVID:
- Suspected / Confirmed COVID Patient Investigation & Management:
- Investigations (note: these are not routine suggestions and should be considered on a case by case basis after d/w a senior clinician):
- CXR
- U&E / FBP / LFT’s / Blood Cultures
- ECG
- COVID / ILI PCR (?also consider Rapid Flu test – for disposition planning)
- Consider risk stratification biochemistry (not to be ordered in ED) – D-dimer / LDH / PCT / Trop / BNP
- Initial COVID-19 Risk Assessment Tools (MuLBUSTA / CURB65 / QSOFA / SaO2)
- COVID Admission Assessment Tool (internal)
- Clinical Note Documentation in PPE Areas – a how to guide
- “ED Clinical Notes” internal link to W Drive (insert this into the file browser): W:\Emergency\SCG\EDClinicalNotes
- Mx Bilateral Pneumonia / Pneumonitis (specifics should be discussed with ED / COVID Consultant / ICU / Anaesthetics as appopriate)
- Consider covering with broad spectrum IVAB’s (ie. ceftriaxone / azithromycin), OR Tamiflu (if influenza positive)
- Cautious use of IV Fluid Therapy
- Early Goals of Care Discussions (see WA DOH: Goals of Care in the COVID-19 environment)
- Oxygen to maintain SAO2 ~90-95%
- Oxygenation Escalation Pathway
- COVID Patient Intubation Guidelines – call Special Anaesthetic Service (SAS) x71242
- If SAS not available:
- Ventilator Settings for COVID-19 Respiratory Failure
- Video Explanation 1: COVID Ventilator Settings – with Dr Katie Wilson
- Video Explanation 2: Setting up the Ventilator (Hamilton T1 & Oxylog 3000) for Ventilating the COVID-19 Patient – with Dr James Rippey
- NEJM COVID-19 Patient Simulators:
- Investigations (note: these are not routine suggestions and should be considered on a case by case basis after d/w a senior clinician):
- Transport of COVID Confirmed / Suspected Patients:
- Into the ED – See ED COVID Triage Sieve #2 (low community spread) = Situation from 30/01/2021
- Out of the ED to the ward
- Quarantined Patients being discharged – need to inform Police Quarantine Management (phone 9323 5595 or 9323 5540) prior to discharge, and arrange SJA transfer back to quarantine facility – informing SJA that the patient is currently in enforced isolation / quarantine
- ED Patient Flow:
- Ambulance…
- Medical / Surgical Inpatient Flow – Contact…
- Mental Health Escalation Plan…
- Discharge Advice Sheets:
- WA Health self-quarantine advice sheet general
- Discharge Advice for Patients with URTI / ILI Symptoms Advice – Interim Advice 2nd April 2020: ie. fit for discharge, no recognised risk factors for COVID, not tested for COVID, hence cannot exclude COVID
- DOH WA Self-Isolation Advice – Information for travellers going home, close-contacts and those tested for COVID-19
- COVID-19 Testing & Notification:
- WA COVID Clinic Locations
- COVID Clinic at SCGH
- COVID Clinics FAQ
- Handout for those who have had a COVID test – ie What do you do while waiting for test results?
- COVID Testing Criteria
- Handouts for different patient categories:
- Had COVID Test – ie What do you do while waiting for test results?
- Confirmed COVID cases
- DOH WA Self-Isolation Advice – Information for travellers going home, close-contacts and those tested for COVID-19
- WA DOH novel coronarvirus Contact Guidelines (internal)
- WA COVID Clinic Locations
SCGH ED Infection Prevention & Control Practices
- Relevant Policy Documents:
- SCGH – Coronavirus (COVID-19) Interim Infection Prevention and Control Policy (internal)
- WA DOH – Coronavirus Disease-19 (COVID-19) Infection Prevention and Control in the Hospital Setting
- Communicable Diseases Network Australia (CDNA) National Guidelines for Public Health Units – Coronavirus Disease 2019 (COVID-19)
- Staff
- Hand Hygiene
- Personal Protective Equipment (PPE):
- Identification and Use of PPE in the Clinical Setting During the Coronavirus (COVID-19) Pandemic Policy
- Sequence for Donning and Doffing
- Applying PPE for COVID-19 video
- Specimen Collection COVID-19 and Influenza
- Application and fit checking of P2/N95 Mask (internal)
- PPE & Procedures Permitted for Different Patient Categories / Areas
- Green Assessment
- Green Resus
- Green Trauma
- Orange Assessment
- Orange Resus
- Orange Trauma
- Red AIIR / ISO
- Red Walled OBS 1-6
- Red Unwalled OBS 7-16
- Conservation of PPE Measures
- Cleaning of Clinical Areas
- Who to call?
- Room cleaning times?
- Respiratory Procedures / CPR & HCW Transmission – Video Explanation by Dr Celenza (password protected)
- Patient
- What Precautions (CDNA Australia COVID-19)
- No AGPR’s / Not high secretions = Contact / Droplet Precautions
- AGPR’s / High secretions = Airborne Precautions
- See above: PPE & Procedures Permitted for Different Patient Categories / Areas (under Staff heading)
- What Precautions (CDNA Australia COVID-19)
SCGH ED Health Care Worker Occupational, Health and Safety Advice
- Staff Wellbeing:
- SCGH COVID-19 and your Wellbeing webpage (internal)
- Occupational Health & Safety SCGH Contacts (internal):
- OSH SCGH – 6457 3414
- Human Relations (HR) SCGH
- Employee Assistance Program (EAP) – free confidential counselling, coaching and support for workplace and personal issues as well as critical incident management
- SCGH ED Specific Wellness Resources:
- Medical Staff Wellness Amongst the COVID-19 – Download link for Powerpoint presentation by SCGH ED Consultant Dr Jason Scop
- Staff Wellbeing within the Pandemic – short (<5min) video by Dr Nick Martin discussing the issue of staff well being and Mx strategies
- Other:
- Resilience Training for Healthcare Workers
- A 3-session video course developed to by the Massachusetts General Hospital, USA: “to support our frontline healthcare providers working tirelessly to care for those infected with COVID-19.”
- Resilience Training for Healthcare Workers
- Health Care Worker with Respiratory Tract Illnesses (RTI’s)
- If you experience “flu-like” symptoms you can call the dedicated WA Health Staff COVID-19 Call Centre on 1800 955 765
- If COVID testing (see latest SitRep for indications), then isolate until test results (Self-quarantine and testing for COVID-19) – Test Results Enquiry Line 1800 313 223 (8am – 4pm)
- Negative
- as for SCGH ILI Policy (see below)
- Positive (as per Coronavirus Disease 2019 (COVID-19) – Communicable Diseases Network Australia (CDNA) National guidelines for Public Health Units)
- the person has been afebrile for the previous 48 hours;
- resolution of the acute illness for the previous 24 hours
- be at least 7 days after the onset of the acute illness;
- PCR negative on at least two consecutive respiratory specimens collected 24 hours apart after the acute illness has resolved
- Negative
- If not COVID testing, then SCGH ILI Policy:
- Influenza confirmed:
- “should not return to work until either 72hours since commencing oseltamivir treatment, or 7 days have elapsed since onset of symptoms”
- URTI / ILI:
- “exclude from duty until afebrile and acute symptoms have settled (~3- 5 days)”
- Influenza confirmed:
- Health Care Workers Considered Close Contacts of Confirmed COVID-19 Case
- The following HCWs must not care for a suspected or confirmed case of COVID-19 (as per SCGH Infection & Control Policy: Coronavirus (COVID-19) – Interim Policy):
- pregnant women
- individuals with chronic respiratory conditions including asthma (requiring regular preventative medication), COPD
- mobidly obese
- persons with chronic illness predisposing to severe disease such as:
- cardiac disease, excluding simple hypertension
- diabetes mellitus
- chronic renal disease
- haemoglobinopathies
- immunosuppression, including that caused by cancers, medications or by HIV/AIDS infection
- chronic neurological conditions
SCGH Other Departmental COVID-19 Plans
- SCGH Hospital
- Pandemic Influenza Management Plan (Internal)
- SCGH Respiratory
- Respiratory Escalation Plan – there is one!
- SCGH ICU
- ICU Escalation Plan – there is one!
- SCGH Anaesthesia
- COVID-19 Anaesthetic Induction Video – in OT
- COVID-19 Emergency Intubation Video – in Respiratory Ward
- COVID-19 Intubation / Extubation Checklist for Theatre
- COVID-19 Anaesthesia Equipment Checklist
- COVID-19 Theatre Preparation Checklist
- Special Anaesthetic Service (SAS) Team – COVID-19 intubation guideline
- COVID-19 Anaesthetic Induction Video – in OT
- SCGH Infectious Disease
- Pharmacological Management of Confirmed COVID-19 Patients – pending
WA Department of Health Guidelines / Updates
- Latest:
- Situation Reports (internal)
- COVID-19 Information for Health Professionals
- includes the latest clinician alerts and testing criteria
Global COVID-19 Resources
COVID-19 Data
- Australia:
- Charting the COVID-19 spread in Australia – ABC News article regularly updated
- COVID-19 Live – updated Australian data including ICU admissions
- COVID-19 Case Tracker Australia
- WA Health: WA COVID-19 Cases Daily Snapshot
- World:
- WoldOmeter: Coronavirus Cases
- WHO: Novel Coronavirus (COVID-19) Global Cases Map
- Johns Hopkins: COVID-19 Global Cases Interactive Map
- Nextstrain real-time tracking of the COVID-19 pathogen – animation
COVID-19 Overview
- Coronavirus disease 2019 (COVID-19) – Overview of COVID-19, including assessment and management, from an Australia and New Zealand critical care perspective, by the team at LITFL
- Coronavirus: Why You Must Act Now – Tomas Pueyo
- What we can learn from the countries winning the coronavirus fight – ABC
- Simulating an Epidemic – youtube video showing various animations based on mathematical modelling and the effects of population and viral factors – 27/03/2020
- Nice video summaries (~40-50mins each) on some key COVID-19 science with Ninja Nerd Science:
- COVID-19 | Coronavirus: Epidemiology, Pathophysiology, Diagnostics – 15th March 2020
- COVID-19 | Coronavirus: Treatment, Prognosis, Precautions – 18th March 2020
- COVID-19 | Coronavirus: Virology, Epidemiology, Pathophysiology | APRIL UPDATE – 21st April 2020
- COVID-19 | Coronavirus: COVID-19 Diagnostics – 22nd April 2020
International & National Agency Resources
- WHO – Country & Technical Guidance – Coronavirus disease (COVID-19)
- CDC US – COVID-19 Information for Healthcare Professionals
- Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance)
- Implementing Home Care of People Not Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19) (Interim Guidance)
- Discontinuation of Home Isolation for Persons with COVID-19 (Interim Guidance)
- Discontinuation of Transmission-Based Precautions and Disposition of Hospitalized Patients with COVID-19 (Interim Guidance)
- Europe EDCD – COVID-19 Information
- UK NHS – Coronavirus (COVID-19): UK government response
- Australian Health Department – Coronavirus (COVID-19) resources
- Western Australian Department of Health – Coronavirus (COVID-19)
- ACEM – COVID-19 Update
- AMA – Latest information on COVID-19
- First Affiliated Hospital, School of Medicine, Zhejiang University, China “Handbook of COVID-19 Prevention and Treatment” – This handbook was based on the guidelines for prevention, control, and diagnosis and treatment of the National Health Commission of China.
FOAMed Resources
- Oxford CEBM COVID-19 Evidence Service (FAQ with EBM)
- Critical Care Northamptom: COVID-19 – Your one-stop resource!
- RebelEM: COVID-19: The Novel Coronavirus 2019
- RebelEM: COVID-19 surge prevention
- Propofology: COVID-19 Resource page
- Coronavirus Tech Handbook – Resources for Doctors
- St Emlyn’s: Covid-19 Podcast from Italy with Roberto Cosentini.
- LITFL: COVID-19 airway management: better care through simulation
- LITFL: COVID-19 a 3-step approach to intubation
- LITFL: Preparing for the COVID-19 pandemic
- EMCrit: COVID-19
- CanadiEM: COVID-19: Fast Facts on the Coronavirus Outbreak
- MedCram: COVID-19 Update Videos
- JAMA: Coronavirus in Italy – Report From The Front Lines
- COVID-ready communication skills: A playbook of VitalTalk Tips (also available on their free VitalTalk App for iPhone & Android)
- MDCalc – COVID-19 Resources Center
Consensus Statements by Professional Bodies / Societies
- Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group – MJA 16/03/2020
- The Australian and New Zealand Intensive Care Society (ANZICS) COVID-19 Guidelines – 16/03/2020
- ILCOR – COVID-19 infection risk to rescuers from patients in cardiac arrest – 31/03/2020