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