COVID-19 Guidelines & Resources

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
  - Cubicle Designation Preference for Aerosol Generating Procedures (AGPs)
  - Defining Aerosol Generating Procedures (AGPs)
- 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)
- 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

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
- Mental Health Patients
  - Mental Health Infection Control Directions regarding COVID-19 – 6th April 2020
- Cubicle Designation Preference for Aerosol Generating Procedures (AGPs)
  - Defining Aerosol Generating Procedures (AGPs)

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:
        SCGH ED Intubation & Ventilation Guidelines for COVID-19 patients
        SCGH ED COVID-19 Intubation Video – with Dr Nick Martin
    - 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:
  - COVID-19 Primer: Virtual Patient Simulation
  - COVID-19 Rx: Treatment Simulations

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 Observation Ward/s Admission Criteria

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)

COVID-19 Vaccine Related Information:
- Adverse Events
  - Where to report adverse events:
    - Western Australia Vaccine Safety Surveillance (WAVSS) System
  - Vaccine Induced Immune Thrombotic Thrombocytenia (VITT):
    - THANZ Advisory Statement for Haematologists: Suspected Vaccine Induced Prothrombotic Immune Thrombocytopenia (VIPIT)/Vaccine induced immune thrombotic thrombocytopenia VITT)
    - DOHWA: VITT Clinican Alert (16th of April 2021)

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
  - 5 Moment for Hand Hygiene
  - How to wash your hands PROPERLY!
- 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)

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.”

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
- 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)”

Health Care Workers Considered Close Contacts of Confirmed COVID-19 Case
- See latest: Coronavirus Disease 2019 (COVID-19) – Communicable Diseases Network Australia (CDNA) National guidelines for Public Health Units

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