Due to the increased concern and ongoing changes regarding the spread of (COVID-19) Novel Coronavirus, Integritas has created this page to ensure that our team has the most recent, up-to-date information, including education on newly released information (CDC, IDPH, NIH, etc.), best practices and also providing resources to the facilities we serve.
Stay updated here:
- ACEP Covid
- European CDC Covid
- IDPH Covid
- CDC on Covid
- ACEP has a great Coronavirus list-serve. You may want to change your settings to daily digest as there is a constant flow of emails and responses.
- Page with multiple resources via EMRap/ HIPPO
- Amazing App with links to Covid-19 resources
- Covid Texbook by EMCrit
- Handbook of COVID-19 Prevention and Treatment
- EBMedicine Coronavirus-COVID-19 3222020
- Courses on Critical Care Medicine from Society of Critical Care Medicine
- Society for Hospitalist Medicine free courses
- ACEP has partnered with EvidenceCare on the development and release of COVID-19 pathways
- Course from Harvard Medical school on Covid
- COVID-19 Personal Checklist
- COVID-19 Healthcare Planning Checklist
- COVID-19 Hospital Preparedness Checklist
- COVID-19 Emerging Infections – PATIENT TRANSPORT CHECKLIST
- Recommend that directors consider meeting weekly with your hospital to ensure everyone is on board with the plans.
- Converting rooms to negative pressure: airborne negative pressure room conversion
- Consider that you may be caring for patients in OBS status while waiting for them to transfer.
- Start discussing end of life planning with all patients >60 years of age.
- At CAHs, we are likely going to be caring for more post-vent patients and more swing bed patients.
- Start talking to your local SNFs about protocols for post-acute patients to be able to return to a SNF and not stay in a hospital room.
- IF we have to keep a vent, you will have support from your CMO and/or our Intensivists.
Important Miscellaneous Notes:
- Don’t panic.
- Do not make your own protocol.
- Shave your face. PAPRs and CAPRs are in limited supply. We can use N95s for the whole shift while they are still available.
- Please do not publicly disagree with the current processes while in the hospital. You are the leader when you are on shift and it is important for effective teamwork that your team is not fearful and frustrated. Please reach out to your director or CMO if you have concerns.
- Up to half of patients present with a digestive symptom as chief complaint, they have worse clinical outcomes and higher risk of mortality. half covid patients present just with diarrhea
- Providers – plan on having your temperature logged 1-2 times a shift. This is an important part of keeping our patients and other providers safe.
- No visitor policy.
- EMS should avoid nebs and should be wearing PPE for all their calls.
- Registration staff need to be protected. If they cannot be behind glass, then consider fit testing and use of an N95 during their shift. They need protection from sick patients.
- Patients and visitors should be screened and immediately masked at facility entrance.
- No handshaking. Upsell to the patients that while you are so thankful for them, you cannot shake their hand at this time. Remind them that you have seen a lot of patients already and you want to protect everyone by reducing the spread of germs. We have to reduce contact and perform excellent hand hygiene.
- Respiratory and Gastrointestinal Febrile Illness Questionnaire
- Guidelines For Completing COVID rev
PPE Use and Cleaning:
- Using your PPE safely: https://youtu.be/bG6zISnenPg
- Facilities in affected areas are switching to droplet and contact precautions rather than airborne due to lack of N95 supplies.
- Surgical masks can be appropriate for situations where there is not aresolization and patient is wearing a mask (correctly).
- ACEP on using N95 for longer https://www.acep.org/corona/covid-19-articles/aceps-position-on-ppe-use/
- Recommend using a surgical mask over the N95 to prevent contamination.
- Evidence for ways to decon your N95
- 3M guide to respiratory Cleaning_Disinfecting
Workup, Testing, and Management:
- HIPAA – do not tell housekeeping, etc., when you suspect Covid. You wouldn’t tell them who has chlamydia. Just have them do a normal Airborne cleaning of the room. They have the protocols.
- Testing is still not available for most of our patients.
- IDPH testing 04.14.2020 (authorization is no longer required)
- COVID-19 Lab Specimen Protocol 3.19.2020 AND LabCorp COVID-19 (NP & OP) Specimen Collection Instructions 3-13_FINAL
- Be Agile and just use the portable CXR in the department or start using ultrasound for evaluation.
- Refrain from moving Covid-suspicious patients out of the ED for X-rays or CT scans.
- When to CT a Covid suspect
- Lymphopenia, thrombocytopenia, and elevated INR seen sometimes.
- Workup of Covid-19 patients, lab tests, etc COVID-19 Clinical Evaluation Guide
- Clinical workup and Treatment options COVID-19 Treatment Algorithm
- COVID – ED Clinical Guidelines 3.25.20
- COVID-19 TREATMENT ADULT Algorithm 04142020
COVID-19 pathway (via USACS) for Risk of Decompensation within 24 hours.It can be accessed here: https://covid19.evidence.care/dashboard/covid/search
- Sick Covid-19 patient management in the ED – SCCM-COVID-19-Infographics1
- ICU management of Covid-19 patient – SCCM-COVID-19-Infographics2
SCCM evidenced based medicine guidelines – COVID19-Society of Critical-Care Medicine Guidelines
- Rebel EM guide
- Try to avoid NIV (Bipap or CPAP).
- Use your HFNC.
- Early intubation with Glidescope using PAPR/CAPR is preferred. At a minimum Full PPE and N95 or respirator.
- Nebulizers will spread the virus. Avoid all nebulizers unless in negative pressure room and all staff uses PAPRs in room. Use MDI when able.
- Consider “long acting B’s”, like Brovana (BID). We can have “auto-sub” neb to MDI when we have more…
- Intubation of suspected Covid
- COVID 19_ Protected Controlled Intubation & Protected Cardiac Arrest DV.3 Mar 8 2020 COMMENTS Invited.docx
- Management of Acute Respiratory Symptoms during COVID-19 Pandemic 032020…
- COVID-19 Intubation Checklist – v6
- Steroids probably don’t hurt. Don’t help much unless COPD type patients.
- Zithro/Chloroquine, antivirals, and others have inadequate determination as to helpfulness right now. Not ready for use.
- End of life care in the emergency department for the patient imminently dying of a highly transmissible acute respiratory infection such as covid19
- Documentation should include “contact with and/or suspected exposure to Covid-19 patient” when appropriate.
- Discharge when O2 sats >94%, no respiratory distress, no increase WOB.
- Patient to be informed they have viral illness, no easy way to test for Covid (yet). Recommend that they isolate themselves for 14 days and until >24hrs afebrile in order to prevent spread (of whatever they have).
- Discharge instructions
- Discharge patients with good instructions to return if they worsen.
- Short version: Covid Discharge Instructions Integritas
- Detailed instructions: Self-Quarantine Instructions Covid Nebraska Medicine
- CDC Discharge Fact Sheet: Discharge CDC sick-with-2019-nCoV-fact-sheet
- At Home Isolation: 465259_At-homeIsolation_COVID-19NovelCoronavirus
- Room clean for 2 hours.
- We are talking with our facilities about starting a tele-triage and MSE system where the patients are evaluated in the tent/ trailer/ isolation area and you complete your MSE remotely and discharge the patients who do not need further workup. This will help reduce exposure and reduce PPE use. As we begin this we will send post the procedures and documentation guidelines.
- Tele ED Covid Integritas
- Tele ED Provider information Covid-19 Integritas
- TELEMEDICINE generic POLICY template
Providers – Health and Exposure:
- Exposed staff guide – UCH Employee Exposure Flow Chart FINAL
- Exposed or symptomatic provider guide:
- If you are exposed to a suspected or Covid-positive patient (while you were not wearing PPE) and are asymptomatic, you can return to work but must wear a surgical mask, contact your Director for self monitoring instructions, and report your temp twice per shift.
- If you have any symptoms and do not have exposure to a known COVID case, (for example if you have a cough) you can work but must wear a mask.
- If you have a fever, you must stay home and contact your Director.
- Return to Work guide for Employees Form 5 12 2020 (2)
- IDPH return to work
- Workup of Covid-19 patients, lab tests, etc COVID-19 Clinical Evaluation Guide_ver 3-4-2020_1
- 1a – Sample Collection for COVID19 Testing_Nasopharyngeal
- 2 – PPE – Recommendations Schematic
- 2a – PPE – Summary and Rationale for Recommendations
- 2b – PPE – Donning Doffing Special Contact Droplet
- 3- Ambulatory Settings – Workflow
- 3b – RN Phone Triage Resources
- 3a – RN Phone Triage
- 4 – Immunocompromised Patients – Protocol
- 5 – Pregnancy Protocol
- 6 – Procedural Areas – Patient Symptom Check
Printable Resources for Facilities:
- COVID-19 Flyer
- APIC Do’s & Don’ts – GOWNS (PDF)
- APIC Do’s & Don’ts of Masks (PDF)
- APIC Do’s & Don’ts Respirator (PDF)
- APIC Do’s and Don’ts of Gloves (PDF)
- Implementation of Mitigation Strategies for Communities
- ECDC Infection prevention and control for COVID-19 in healthcare settings
- CDC Flowchart to Identify and Assess 2019 Novel Coronavirus
Forms and tracking sheets:
- Coronavirus PUI Fillable Form
- Newly Admitted Isolated Patients Form
- COVID-19 ED Line Listing Form
- COVID-19 Patient List Form
Airborne – NOT droplet only:
- CDC 2004 on SARS (prior to their 2020 redaction of airborne spread)
- Detection of Airborne SARS Coronavirus 2005
- Transmission of SARS and MERS coronaviruses 2015
- [Detection of SARS-CoV and RNA on aerosol samples from SARS-patients admitted to hospital]. – PubMed – NCBI
- Middle East Respiratory Syndrome Coronavirus Transmission
- Recognition of aerosol transmission of infectious agents
- cidrap Protecting health workers from airborne MERS-CoVlearning from SARS
- Transmission Potential of SARS-CoV-2 in Viral Shedding