Admission & FlowCOVID-19

April 2020

Intended Audience● Clinical staff

Learning Outcomes

This training is designed to highlight points that need to be

considered and put in place when suspected or confirmed COVID

patients present for triage or admission.

By the end of this learning package, you should know:

● How to screen patients for COVID-19 on admission

● How to set up a safe clinical environment/unit to treat COVID-

19 patients

Intended Audience & Learning Outcomes

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1. Patient Screening for COVID-19

Regardless of the

method of admission

every person entering

the hospital MUST be

screened for COVID-19

● This involves the patient answering the questions on the COVID-19 Patient Screening

Questionnaire and the measuring of body temperature.

● The COVID-19 Patient Screening Questionnaire is constantly being updated based

on the most recent government health information.

● The questionnaire identifies if patients are suspected of having COVID-19 and if they

need testing.

● If a patient is suspected COVID-19, then a mask is put on the patient and precautions

are put in place.

● This document may vary slightly between states due to the local outbreak alerts that

need to be considered.

● Staff, visitors or other people who are identified as at risk for COVID-19 will not be

permitted to enter the hospital. These persons need to self isolate as per government

guidelines and seek medical advice.

Screening on admission / entry to hospital

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The most recent Patient Screening Questionnaire is located on the Healthscope Intranet: HINT/Policies & Procedures/COVID-19

There are a number of

ways that a COVID-19

patient can be identified

Flowcharts and pathways

have been set up for each

of these types of

admissions.

● Existing Patients: Some patients have already been screened as safe, admitted, are in the incubation period for

COVID-19 and are unaware. These patients may later develop symptoms.

Any current inpatient that shows fever or respiratory symptoms will have the Screening Questionnaire

applied again.

This could occur for medical, surgical, obstetric, rehabilitation or mental health patients.

If a current inpatient develops the signs and symptoms of COVID-19 they should be isolated in a single

room and a COVID-19 swab MUST be taken. Droplet and contact precautions should be initiated. If

the patient is actively coughing, airborne precautions are to be included as well. Ensure a PPE station

is set up outside the patient room.

● Emergency Department: A number of Healthscope hospitals have Emergency Departments and all have the ability

to test patients. If the hospital is a designated receiving hospital for COVID-19 patients, then an area within the ED

may be set up for patients as they await testing. Alternatively a ward, or area in a ward will be designated for those

patients awaiting swab results. Patients not requiring admission will be sent home to await results.

● COVID-19 Admissions: In some cases, a hospital may receive a direct admission of a patient/s with COVID-19,

direct to a designated Respiratory or Intensive Care Unit.

● Surgical Admissions: If a known COVID-19 patient with mild symptoms requires urgent admission or surgery (eg:

appendicectomy) then these patients may be admitted. Processes for managing the COVID-19 positive patient in the

operating theatre will be initiated.

● Obstetric Admissions: All obstetric patients MUST be screened for COVID-19 pre admission and again upon

admission. Protocols to either admit or transfer the patient will be initiated prior to delivery if the patient is a high risk

of COVID-19 based on their presenting symptoms.

Which patients are screened?

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Flowcharts and pathways are available on the Healthscope Intranet: HINT/Policies & Procedures/COVID-19

All patients presenting to triage MUST be

screened for Covid 19. Any patient presenting

with respiratory symptoms should be considered

as a potential COVID-19 patient until

determined otherwise.

All patients at triage presenting with

respiratory symptoms must put on a surgical

mask. This mask must remain in place until

staff are able to don all necessary PPE and

the patient is placed in the designated

COVID-19 area.

All patients with respiratory disease/failure

are to be immediately placed in the

designated COVID-19 area (ideally a single

room) with droplet and contact transmission

based precautions immediately established.

All patients with respiratory

disease/failure are to swabbed for

COVID-19 on admission.

Once swabbed patients should be moved to

the dedicated COVID-19 ward or other

appropriate designated area to await swab

results.

Emergency Departments: Triage Desk

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● Each Healthscope Emergency Department has a well

established plan and processes to ensure they are prepared

to triage COVID-19 patients.

● Environmental layout, zoning and cleaning, patient flow and

cohorting, infection control requirements, preparation and

separation of clinical treatment spaces, patient assessment

and care requirements and staff safety are all important

aspects that are considered and planned for.

● Most patients who present with COVID-19 symptoms, but

are not acutely unwell, can be tested in the ED and then wait

in home isolation for the test results.

● In some cases, patients with suspected COVID-19 may be

transferred from the ED to a designated COVID-19 receiving

hospital (pubic or private) rather than being admitted.

● In other cases, patients will be admitted to a Respiratory Unit

or Fever Clinic while awaiting their test results

● The Australasian College for Emergency

Medicine provides some very clear

guidance of this in their Clinical

Guidelines for the management of

COVID 19 in Australasian emergency

departments text v1.0 March 2020

Receiving COVID-19 patients in the ED

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● A new Disaster Code of ‘COVID-19’

has been added into webPAS at all

Healthscope & ACHA Hospitals to assist

with the reporting and management of

COVID-19. This will allow appropriate

Emergency and Admitted patients to

be assigned to this code as required.

● Any patient suspected of COVID-19 must

have COVID-19 listed as their presenting

complaint in the Webpas Triage screen.

● COVID 19 also needs to be recorded in

the free type triage comment box, along

with additional information relating to the

presenting complaint.

Triage documentation

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ED Registration

● Select ‘COVID-19’ in the ‘Disaster Code’ field at bottom right

of the registration screen to link the patient to the disaster.

● Disaster Identification # should be left blank if the results are

unknown or type ‘NEGATIVE’ or ‘POSITIVE’ if the status is known.

Triage documentation

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2. Setting up a COVID-19 Unit

In many Healthscope hospitals, a COVID-19 ward will not be required, as these hospitals are not intending to treat large

numbers of patients with the virus.

ALL Healthscope hospitals are prepared to care for a COVID-19 suspected or confirmed patient if required, within a

single room.

● All SUSPECTED cases of COVID-19 are to have the same precautions as confirmed cases, until test results are returned.

● This is NO DIFFERENT to managing any patient on droplet and contact precautions, eg: influenza, whooping cough,

bacterial meningitis.

● If there is one patient on these precautions within the hospital, this will be managed within a single room, with clear signage

and provision for donning and doffing PPE.

● Even if your hospital is not planning to treat COVID-19 patients, you need to be prepared, in case a patient cannot be

transferred out.

SOME Healthscope hospitals are planning for treatment of more cases, if required.

● In this circumstance, a pod (4 bed area) or ward will be designated as the COVID-19 Unit.

● Patients awaiting test results (suspected cases) must be kept separate from confirmed cases of COVID-19.

● Some Healthscope hospitals also have plans for a larger surge, where more than one ward may treat COVID-19 patients.

With the success of social distancing in the Australian community, this will hopefully not be required.

Single Isolation Room vs Unit/Ward Set-up

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COVID-19 wards, units or

pods should be set up to

localize patients to a specific

geographical area and

minimise exposure of staff and

other patients to COVID-19.

Each Hospital Executive team

has developed detailed

Operational Readiness

Plans and checklists to guide

this set up if required.

This requires the development

of a trained workforce and the

design of functional patient and

work flow patterns to support the

implementation of an effective

isolation unit/ward.

To reduce the spread of

COVID-19 to other patients

and to healthcare workers,

patients should be cohorted

where possible into dedicated

isolation pods, units or wards

or transferred to hospitals

where isolation is possible.

Setting up the environment

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Dedicated COVID-19 wards, units or pods should be

set-up to minimise exposure

● Provide clear signage as to preferred patient flow routes and what routes

are restricted – e.g. ‘clean’ routes for staff and visitors should ideally be

available that patients are not being moved through

● If appropriate, Hot, Warm, Cold zones can be established, depending

on the size of the ward/unit (refer separate guidelines).

● Patient flow routes should avoid contamination of PPE.

● Clean routes should avoid exposure to areas where testing and aerosol

generating procedures (AGPs) may be performed .

● All those entering the unit must be signed in, including staff and visitors.

● An Entry / Exit should also be clearly marked, with space for individuals

to donning & doffing PPE.

Designating areas

A dedicated ward/pod should be

identified to care for suspected

COVID-19 patients.

It is preferable that isolation wards /

areas have a separate entrance or

can be segregated from the rest of

the hospital to minimize unnecessary

foot traffic through the isolation ward /

area.

For more information, refer to

guidelines for COVID-19 Ward/Unit

Setup on the Healthscope intranet.

Setting up the environment

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Where possible, patients should be physically separated between

those that are confirmed, suspected and awaiting testing.

Only confirmed COVID19 positive patients should housed together.

Where rooms are shared:

● Only confirmed COVID-19 patients should be housed together

● Suspected COVID-19 patients cannot share rooms

● Beds must be spaced at least 1.5 metres apart and the curtains

drawn.

Where possible, single and negative pressure

rooms should be used.

Setting up the environment

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Setting up the environment

Designating areas

A dedicated ward/pod should be

identified to care for suspected

COVID-19 patients.

It is preferable that isolation wards /

areas have a separate entrance or

can be segregated from the rest of

the hospital to minimize

unnecessary foot traffic through the

isolation ward / area. In some

hospitals this may be challenging but

characteristics in the COVID-19:

Principles of COVID-19 ward/unit

setup guidelines should be reviewed

and followed.

Characteristics of selected

potential COVID-19

wards/pods

Ideal characteristics of wards/pods

selected should include the capacity

to care for critically ill patients:

● Two oxygen outlets

● One air outlets

● Two suction outlets

● Twelve mains electricity outlets

● Appropriate physiological

monitoring

● Negative pressure rooms (2)

Next stepsCOVID-19 Principles of

COVID-19 ward/unit setup

are available on the Intranet

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Setting up the environment

Set up of COVID ward / Pods

Where possible, single and negative pressure rooms

should be available.

Ideally, any AGPs should be performed in a negative

pressure room. If negative pressure rooms are not

available, single rooms are sufficient.

Where rooms are shared, beds must be spaced at

least 1.5 metres apart, preferably more to allow for

space for healthcare workers.

Where rooms are shared, only confirmed COVID-19

positive patients should housed together

Patients who are suspected of COVID-19 and

awaiting COVID-19 PCR testing results should

be in single rooms to avoid the risk of cross infection.

Where possible, separate pods/areas should be

established for patients with suspected COVID-19 and

those with confirmed COVID-19.

There should be a clearly marked single entrance

and exit with a PPE station for staff and other

essential visitors to hand wash, sign in and don PPE

when entering

the unit.

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Establishing a COVID-19 On-Call Roster

It is critical to involve site VMOs in the set up of a

COVID-19 ward.

A COVID-19 VMO roster should be established as

soon as the need for the COVID-19 ward is initiated.

Respiratory, General Medicine and Infectious Diseases

Physician’s are appropriate to service the roster.

Respiratory, General Medicine and Infectious Diseases

Physicians are likely to be involved in the COVID-19

wards in the public sector and will have an on call

component to these appointments as well.

If the VMO is on call for the COVID-19 ward in the

public sector they cannot be on call for the COVID-19

ward in the private sector due to the risk of transfer of

disease.

You will need to work with your VMOs to establish the

best way to form a roster. The VMOs on the roster will

be the only doctors who enter and treat patients on the

COVID-19 ward.

The COVID-19 on-call VMO will liaise with the primary

specialty and co-ordinate care until the patient’s

COVID-19 status is known. If negative, the patient will

be transferred to a suitable ward and the care of the

primary specialist. If positive, the patient is admitted to

the appropriate COVID-19 positive ward and remains

cared for by the COVID-19 doctor with that doctor

liaising with any other specialist required to co-ordinate

the ongoing care of the patient.

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● Only minimal supplies

should be stored within the

COVID-19 patient room.

This includes patient care

supplies, medical supplies

and linen etc.

● Trolleys with equipment or

supplies should be collected as

needed and placed outside the

patient area.

● A buddy or runner, who is

positioned outside the patient

area, can pass over any required

equipment or supplies as they

are needed. This is critical to

ensure minimal wastage of

all supplies.

● Any supplies that are within

the patient environment

must be disposed of or

reprocessed if they are

removed from the room or

at the time the room is

terminally cleaned.

Supplies in the patient room

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Equipment in patient rooms

● If it does not impede normal operating, equipment in a COVID-19 patient’s room

can be covered with clear plastic. The equipment can then be viewed and

operated through the plastic with only the connecting cabling extending out from

under the plastic.

● For all electrical equipment it is important to ensure sufficient airflow under

any plastic drape.

● When equipment is removed from within the patient environment, or the patient

is discharged from the room, the plastic can be removed and discarded.

● The equipment is then cleaned as per manufacturer’s guidelines. Full droplet

and contact precaution PPE is to be worn during the cleaning process.

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3. Keeping yourself safe

Physical distancing and

hand hygiene

Maintain physical distancing and hand

hygiene are key COVID-19 safety

strategies and they must be applied at all

times.

Face masks

All staff working in high risk areas are

required to wear (at a minimum)

surgical face masks for the duration of

the shift. This includes Emergency

Departments, Intensive Care Units

and Respiratory Units.

Donning and doffing buddy

It is a requirement that staff have a

donning and doffing buddy present

when undertaking any PPE donning

and doffing procedures.

Keeping yourself safe

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Scrubs and work uniforms

● Scrub use in interventional suites, operating

theatres and delivery suite continues

as normal.

● No personal scrubs are to be worn.

● Scrubs must not leave the hospital and must

be laundered by the hospital laundry service.

● Staff wearing uniform should, where possible,

change into and out of uniform on site. Where

this is not possible, staff are advised to go

directly home at the end of their shift to

launder any items worn at work.

● Guidelines about management of scrubs

and work uniform are located on the COVID-

19 intranet site and are updated regularly.

Depending on individual site risk

assessments, hospitals should

work towards a system where

wearing of scrubs occurs in:

● Emergency Departments

● ICU

● Respiratory Units

● Staff treating suspected or

confirmed COVID-19 patients

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PPE stations

• For areas where there are a number of patients, with staff

wearing full PPE in the patient zones as well as shared zones,

then the PPE station is set up at the entrance to this area.

• If PPE is only required in the specific patient zones, and not in

the shared zones, then the PPE station should be at the

entrance to the patient zone.

The location of PPE stations will be dependent

on the set up of the COVID-19 area.

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Following this learning module,

you should now understand

how to:

● How to screen patients for COVID-19 on

admission

● How to set up the environment to treat

COVID-19 patients

Next steps

● Complete other learning modules,

relevant to your role.

● Visit HINT for more information.

● Speak with your Unit Manager/Team

Leader if you have any concerns

or would like further information.

Next steps

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