PLANNING
Pre-plan for how to best transport a patient from the ED to the inpatient unit. Use security to facilitate clearing the route, hold the elevator, and ensure that the elevator is cleaned after patient transport.
Develop a department plan designating which areas of the ED will be dedicated to droplet precautions and which areas are negative pressure rooms, appropriate to airborne precautions.
- For areas without an “ante-chamber,” consider creating a taped “warm zone” outside of the room for proper doffing.
- Ensure donning/doffing stations are set up with all needed supplies.
- Consider taking a photo of the station to post in order to ensure proper set-up.
- How will you secure these supplies (especially the hand-gel and wipes)?
- Consider cohorting patients with mild illness who are “patients under investigation” in internal waiting rooms away from well patients, or those who could be immunocompromised.
- Use phones or tablets with ability to display video communication in the patient rooms to interview non-critically ill patients in order to reduce trips in and out of the room, and to coordinate with nursing or respiratory therapy when they are at the bedside.
MOVEMENTS
Consider how patients will be transported from the waiting room through the ED to the isolation or precautions room:
- Which route will they take to minimize exposure from the ED to the floor/unit dedicated within your hospital?
- Which route will your used supplies take to be cleaned?
- How will your nasal swabs be transported to the lab (eg. We are not using our tube system)?
Diagnostics:
- Develop plans for terminal clean of CT scan rooms and other bedside diagnostic equipment (portable radiology, ultrasound, etc).
- Will you have a dedicated ultrasound?
- With our radiology colleagues, we have developed a process to perform portable radiographs through the door window for patients in isolation, reducing risk to staff and need for cleaning of the portable units.
- Radiograph quality is acceptable using this technique for our radiologists, although a lateral view is not obtained.
RESOURCES
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For AAMC clinical guidance repository with protocols from multiple institutions and alignment summaries: https://www.aamc.org/coronavirus-covid-19-clinical-guidance-repository#alignment.
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NIH Treatment Guidelines: https://www.covid19treatmentguidelines.nih.gov/.
- For COVID-19 EMS resources, including video updates, see EMS Online Infectious Disease Safety Information web page.
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PPE Video for Pre-training and “Just in Time” Review
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Watching the video does NOT qualify as appropriate refresher training. We recommend that you review the pre-training video before your training session.
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CDC Website for Current Literature
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National Academy of Medicine: Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2 outline important concepts in health care systems preparedness.
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Hick, J. L., D. Hanfling, M. K. Wynia, and A. T. Pavia. 2020. Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2. NAM Perspectives. Discussion paper. National Academy of Medicine. Washington, DC. https://doi.org/10.31478/202003b
UW Medicine COVID-19 Resource Site
See UW Medicine COVID-19 Resource Site for more screening and testing algorithms, policy statements, and additional links.
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