ED/PED COVID RESPIRATORY PATHWAY 3/27 UPDATE · 2020-03-28 · ED/PED COVID RESPIRATORY PATHWAY...

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ED/PED COVID RESPIRATORY PATHWAY 3/27 UPDATE Patient presents to the UNC ED, Hillsborough ED, or Urgent Care with FEVER OR RESPIRATORY SYMPTOMS Close contact with lab-confirmed COVID-19 patient within 14 days of sx onset, or ongoing COVID eval ? YES NO At UNC ED, all respiratory patients go to Team D or Team D waiting Don PPE (mask, faceshield, gown, gloves) and manage as indicated NO NO DISCLAIMER: THIS WORKFLOW MAY CHANGE ABRUPTLY. TEXT BEN SMITH 910-617-2739 OR DAN PARK 703-887-8383 WITH ISSUES WITH THIS PATHWAY Don PPE (N95/PAPR, gloves, gown, faceshield) and utilize existing workflow to evaluate and treat patients in Team D (rooms 63, 64 70, 71, 72, 73, 74, 75) or HBH (rooms 1, 2, 3, 4). Stable for outpatient workup? Is it after 3:30pm? YES Refer directly to RDC IF pt meets RDC testing criteria (Dotted box to left and Appendix A) NO YES Admission anticipated? Order Respiratory Pathogen Panel with Reflex COVID-19 PCR [LAB5812R] (The tests are run in parallel despite the name) Follow approriate admission steps for your area. Pediatric admit pathway in (Appendix B) YES Discharge home, instruct to isolate at home and go to RDC between 9a-4p on the next day it is open (Appendix A) Order ONLY Rapid Influenza/RSV PCR with Reflex COVID-19 PCR [LAB5811R] Add patient to Shared Patient List for follow up and discharge patient using smartphrases: Adult: .bascovidlowriskdischarge Peds: .pedcoviddischarge Viral illness suspected? Continue evaluation & management off COVID pathway YES NO MASK PATIENT! REVISED RDC TESTING CRITERIA EFFECTIVE 3/23 1. Developed non-allergy respiratory sx of cough or SOB in past 7 days AND 2. Meet ONE OR MORE of these criteria: a. Close contact with person dx with COVID-19 b. Works in healthcare setting c. >65 yo or <2 yo d. Pregnant or 2 weeks postpartum e. Morbidly obese: BMI>40 f. Chronic condition: DM, immunosuppressed, or any other condition listed in Appendix A PEDS? YES All Peds patients placed in PED rooms (1, 2, 8, or 10) If no rooms wait in Team D waiting NO MASK PARENT! All fever/respiratory patients brought into ED through team D D

Transcript of ED/PED COVID RESPIRATORY PATHWAY 3/27 UPDATE · 2020-03-28 · ED/PED COVID RESPIRATORY PATHWAY...

Page 1: ED/PED COVID RESPIRATORY PATHWAY 3/27 UPDATE · 2020-03-28 · ED/PED COVID RESPIRATORY PATHWAY 3/27 UPDATE Patient presents to the UNC ED, Hillsborough ED, ... in PED rooms (1, 2,

ED/PED COVID RESPIRATORY PATHWAY 3/27 UPDATEPatient presents to the UNC ED, Hillsborough ED, or Urgent Care with

FEVER OR RESPIRATORY SYMPTOMS

Close contact with lab-confirmed

COVID-19 patient within 14 days of sx onset, or ongoing

COVID eval? YES

NO

At UNC ED, all respiratory patients go to Team D or

Team D waiting

Don PPE (mask, faceshield, gown,

gloves) and manage as indicated

NO

NO

DISCLAIMER: THIS WORKFLOW MAY CHANGE ABRUPTLY. TEXT

BEN SMITH 910-617-2739 OR DAN PARK 703-887-8383 WITH ISSUES WITH THIS PATHWAY

Don PPE (N95/PAPR, gloves, gown, faceshield) and utilize existing workflow to evaluate and treat patients in Team D (rooms 63, 64 70, 71, 72, 73,

74, 75) or HBH (rooms 1, 2, 3, 4).

Stable for outpatient

workup? Is it after 3:30pm?

YES

Refer directly to RDC IF pt meets RDC testing

criteria (Dotted box to left and Appendix A)

NO

YES

Admission anticipated?

Order Respiratory Pathogen Panel with Reflex COVID-19 PCR [LAB5812R]

(The tests are run in parallel despite the name) Follow approriate admission steps for your area.

Pediatric admit pathway in (Appendix B)

YES

Discharge home, instruct to isolate at home and go to RDC between 9a-4p on the

next day it is open (Appendix A)

Order ONLY Rapid Influenza/RSV PCR with Reflex COVID-19 PCR [LAB5811R]

Add patient to Shared Patient List for follow up and discharge patient using smartphrases:

Adult: .bascovidlowriskdischarge Peds: .pedcoviddischarge

Viral illness suspected?

Continue evaluation & management off COVID pathway

YESNO

MASK PATIENT!REVISED RDC TESTING CRITERIA EFFECTIVE 3/23

1. Developed non-allergy respiratory sx of cough or SOB in past 7 days AND

2. Meet ONE OR MORE of these criteria:a. Close contact with person

dx with COVID-19b. Works in healthcare settingc. >65 yo or <2 yod. Pregnant or 2 weeks

postpartume. Morbidly obese: BMI>40f. Chronic condition: DM,

immunosuppressed, or any other condition listed in Appendix A

PEDS?

YES All Peds patients placed in PED rooms (1, 2, 8, or 10)

If no rooms wait in Team D waiting

NO

MASK PARENT!

All fever/respiratory patients brought into ED through team D D

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  Audience for this document: UNC Health Providers and Staff only 

 

Updated 3/22/2020 For updates/corrections: [email protected]

Revised Guidelines for Testing at RDCs Effective March 23, 2020 Testing Criteria Patients will be eligible for respiratory pathogen testing if they have:

(1) Developed non-allergy respiratory symptoms of cough or shortness of breath in the past 7 days AND

(2) Meet ONE OR MORE of these criteria

� Had close contact (within 6 feet for 10 or more minutes) with a person diagnosed with COVID-19 � Works in a healthcare setting � Is 65 years old or older � Is 2 years old or younger � Is pregnant or postpartum within 2 weeks of delivery � Is morbidly obese: BMI ≥ 40 or 100 pounds over ideal body weight � Has any of the following chronic conditions:

� Diabetes mellitus � Immunosuppression, including caused by medications or by HIV infection � Pulmonary disease, including asthma � Cardiovascular disease � Hypertensive disease � Renal disease � Hepatic disease � Hematologic disease, including sickle cell disease � Neurological condition that limits movement � Moderate to severe developmental delay

In general, patients presenting to any RDC who do not meet above criteria will not be tested for flu or COVID-19. Individual providers can use their judgement to order flu or other non-COVID testing, as they deem appropriate. Testing Process Patients meeting criteria above will be tested first for rapid flu:

Chapel Hill RDC (ACC) Community RDCs (all other locations)

McLendon runs Respiratory Flu/RSV panel Point of Care Rapid Flu

If positive for flu or RSV, COVID test will not be run

If negative for flu and RSV, COVID test will be run

If positive for flu, COVID test will not be sent

If negative for flu, obtain second swab for COVID test and will be

sent to LabCorp

HealthLink and Virtual Care Center messaging will ensure any reference to RDCs refers to evaluation of patient (rather than testing specifically) to help manage patient expectations around testing.

APPENDIX A

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Epic@UNC ASAP – Workflow ISD Training Department [email protected] 3/22/2020 10:44 AM Page 1 of 3

RDC Referral Process – Covid-19

This Tip Sheet outlines the process to follow for patient referral to the RDCs.

Workflow – PROVIDERS

1. Provider determines the need to refer a patient to an RDC.

2. Navigate to the Dispo activity and locate the new widget – RDC Referral (left column under Follow Up for Nurse). Click +New.

3. In the message, click YES to send this message to the RDC schedulers and then choose the Patient-preferred RDC Location. Click Accept to send the message.

4. In the Patient Instructions (top right in Discharge Inst widget), use the SmartPhrase .RDCREFERRALS. There is an English and a Spanish version.

5. Complete the two SmartLists.

A. Choose the patient-preferred location

B. Choose the action (see screenshot for 2nd SmartList). If you choose the 2nd option, the phone numbers will automatically populate or it will identify that there is no phone number recorded.

Daniel Park
APPENDIX A
Daniel Park
Daniel Park
Peds specific RDC
Daniel Park
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Epic@UNC ASAP – Workflow ISD Training Department [email protected] 3/22/2020 10:44 AM Page 2 of 3

Patient Instructions (example)

The 2nd workflow for PROVIDERS ONLY is a new SmartSet within your Dispo activity.

1. Fill out the RDC Referral as above. 2. Navigate to Smart Sets. Enter Covid, press Enter.

This will populate suggestions for Clinical Impression, Discharge Instructions, and will automatically set the ED Disposition to Discharge. Make your choices for Clinical Impression, Discharge instructions and any other pertinent information.

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Epic@UNC ASAP – Workflow ISD Training Department [email protected] 3/22/2020 10:44 AM Page 3 of 3

Workflow – NURSES – RDC Referrals 1. Provider determines (or Nurse determines depending on facility workflow) that a patient needs to be

referred to the RDC. 2. Navigate to your Disposition Activity. 3. Go to the section for RDC Referral (can be found in Discharge and Nurse Discharge sections) of the

Navigator. 4. Follow the steps in the Provider workflow to complete the process, including utilizing the

SmartPhrase in your Discharge Instructions > Patient Instructions as noted in provider instructions. Nurses do not have access to the SmartSets.

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Version 1.1, updated 3/16/2020

Directions to the Respiratory Diagnostic Center from UNC Emergency Department If you were evaluated after 8:00am and before 4:30 pm on a weekday, please proceed directly to the diagnostic center. If you were evaluated on a weekend or after 4:30 pm on a weekday,

you should isolate at home and go to the RDC between 8:30am and 4:00pm M-F.

Address: 102 Mason Farm Rd. Chapel Hill, NC 27514

Turn by turn directions:

1. Proceed down emergency room drive toward Manning Dr. 2. Turn Right onto Manning Dr. 3. Take the next Left onto East Dr. 4. The RDC at the ACC will be on your left in approximately 0.4 miles. 5. You will see signs directing you where to go.

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Version 1.1, updated 3/16/2020

Directions to the Respiratory Diagnostic Center from Hillsborough Emergency Department If you were evaluated after 8:00am and before 4:30 pm on a weekday, please proceed directly to the diagnostic center. If you were evaluated on a weekend or after 4:30 pm on a weekday,

you should isolate at home and go to the RDC between 8:30am and pm 4:00 M-F.

Address: 102 Mason Farm Rd. Chapel Hill, NC 27514

Turn by turn directions:

1. Take I-40 East from Hillsborough. 2. Take exit 266 for NC-86 South/MLK Jr. Blvd and turn Right. 3. Continue straight for 2.6 miles. 4. Turn Right onto W. Cameron Ave. 5. Take the next Left onto Pittsboro St. 6. In 0.2 miles, take a slight Right onto S. Columbia St. 7. Take the next Left onto Mason Farm Rd. 8. The RDC will be on your right. 9. You will see signs directing you where to go.

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Version 1.1, updated 3/16/2020

Directions to the Respiratory Diagnostic Center from UNC Urgent Care Panther Creek Please proceed directly to the diagnostic center. If you were evaluated after 8:00am and before 4:30 pm on a weekday (or between 8:00 am and 11:30 am on a weekend), please

proceed directly to the diagnostic center. If you were evaluated after 11:30am on a weekend or after 4:30 pm on a weekday, you should isolate at home and go to the RDC between 8:30am

and 4:00pm M-F or between 8:30am and 11:00am on the weekend.

Address: 7535 Carpenter Fire Station Rd.

Cary, NC 27519 Turn by turn directions:

1. Head to NC-55 E 2. Turn right onto NC-55 E 3. Continue straight for 0.5 miles. 4. Turn Right onto Carpenter Fire Station Rd. 5. Continue for 1.4 miles. 6. Turn left onto Cary Glen Blvd 7. Turn Left onto Brushy Mountain St. 8. In 486 ft turn left 9. In 256 ft turn left 10. The RDC will be on the left in 217 ft.

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Version 1.1, updated 3/16/2020

Directions to the Respiratory Diagnostic Center from UNC Urgent Care Park West

Please proceed directly to the diagnostic center. If you were evaluated after 8:00am and before 4:30 pm on a weekday (or between 8:00 am and 11:30 am on a weekend), please

proceed directly to the diagnostic center. If you were evaluated after 11:30am on a weekend or after 4:30 pm on a weekday, you should isolate at home and go to the RDC between 8:30am

and 4:00pm M-F or between 8:30am and 11:00am on the weekend.

Address: 7535 Carpenter Fire Station Rd.

Cary, NC 27519 Turn by turn directions:

1. Turn Left onto NC- 54 W 2. Turn Left onto Morrisville Parkway 3. In 3.4 miles turn Right onto NC- 55 W 4. In 0.7miles turn Left onto Carpenter Fire Station Rd. 5. Continue for 1.4 miles. 6. Turn left onto Cary Glen Blvd 7. Turn Left onto Brushy Mountain St. 8. In 486 ft turn left 9. In 256 ft turn left 10. The RDC will be on the left in 217 ft.

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Version 1.1, updated 3/16/2020

Directions to the Respiratory Diagnostic Center from UNC Children’s Urgent Care at Raleigh Please proceed directly to the diagnostic center. If you were evaluated after 8:00am and before 4:30 pm on a weekday (or between 8:00 am and 11:30 am on a weekend), please

proceed directly to the diagnostic center. If you were evaluated after 11:30am on a weekend or after 4:30 pm on a weekday, you should isolate at home and go to the RDC between 8:30am

and 4:00pm M-F or between 8:30am and 11:00am on the weekend.

Address: 7535 Carpenter Fire Station Rd.

Cary, NC 27519 Turn by turn directions:

1. Head west toward Lake Dr. 2. Turn left at the 1st cross street onto Macon Pond Rd. 3. In 1.0 Miles use the right lane to take the ramp to I-40/ Durham 4. Merge onto Wade Avenue 5. In 1.0 miles Merge onto I-40 W 6. Continue for 6.3 miles 7. Take exit 283A for NC-540 W toward NC55/Apex 8. Continue ton NC-540 W 9. Take exit 66A to merge onto NC-55 E toward Cary 10. Turn Right onto McCrimmon Pkwy 11. In 1.1 miles turn Left onto Cary Glen Blvd 12. Turn Left onto Carpenter Fire Station Rd. 13. In 426 ft Turn right and the RDC will be on your right

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Pediatric Specific Respiratory Diagnostic Center

If you child was evaluated after 8:00am and before 4:30 pm on a weekday (or between 8 am and 11:30 am on a weekend), please proceed directly to the diagnostic center. If your child was

evaluated after 11:30 am on a weekend or after 4:30 pm on a weekday, your child should isolate at home and go to the RDC between 8:30am and 4:00pm M-F or between 8:30 am and

11am on the weekend.

Address: 1515 SW Cary Parkway

Cary, NC 27511

Hours: Mon-Fri 8a-5p

Sat 8a-12p

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COVID-19 24/7 Pediatric Admission

Notification Process Date Effective: March 18, 2020

PAC notifies PED COVID attending (Acute/ICU) and continues with normal operations (PAC to

get PED COVID provider on transport call)

TIER 1

COVID Provider contacts Infection Prevention and PLC.Send FYI to Peds Administrator on Call

PAC notify House Supervisor.

House supervisor to notify the PICU or 6CH Charge RN and Manager or Children's Director

Patient Admitted to PICU/6CH

* PUI – Patient Under Investigation by Peds

Admission Coordinator

Referring Provider

Pediatric Admissions Coordinator (PAC)

Text PICU Manager/Children’s Director

PED COVID-19MD

PICU Attending and Ped Administrator on

Call

PICU RN Manager

PICU Charge RN

Patient Admitted

House Supervisor

Ped COVID-19 Patient (+ or PUI) needs admission (via PLC, PAC, PED or Direct Admit

from Clinic)

Daniel Park
APPENDIX B
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COVID-19 24/7 PICU Admissions Notification Pathway

Date Effective: March 13, 2020

Patient Presents for Admission

Infection Prevention

Page: 919-216-2935

Micro LaboratoryDirector On-Call

Emergency Services Director

COVID-19 Attending

Call 919-525-6676*Call 984-974-1805

Administrator On-Call

123-3975

NC State Health Dept

Call 919-733-3419

House Supervisor Call 984-974-5402

Additional Stakeholders

Children s Administrator on call: 123-3975

Director Children s Services: 919-370-2988

PICU Attending Physician: 984-974-5491

PICU Attending On-Call: WebExchange Ped Critical Care

PICU RN Manager: 617-838-0697

Patient Logistics Director: 919-632-5662

Respiratory Therapy Manager on Call: 984-974-6209

Environmental Services: 919-883-6622

ECMO Program Manager: 919-370-2864

CD Director: 919-951-9015

Carolina AirCare SOC via flightwatch: 984-974-2944

Dialysis Manager: 919-740-9424

*Alternate Contact Numbers

Public Affairs: 919-923-2347, 919-457-6347

Emergency Management: 919-883-8948, 919-641-3066

Radiology Leadership: 919-612-8297

Emergency Services Associate Director: 910-619-3980

PICU AttendingCall 984-974-5491

Executive Leadership

Follow normal process

Public Affairs

Call 980-621-1189*

Responsible Providers activate COVID-19 Pathway

(PEM, PAC, etc)

May be delegated

Emergency Management

Notification to additional

stakeholders

Activation of Incident Management Team

Director On-Call

Follow normal process Follow normal process

May be delegated Smart Notice/Texts

PICU Nurse Manager

617-838-0697

Children s DirectorCall 919-370-2988

APPENDIX B