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Table 2 Workflows created for COVID-19 emergency preparedness and response plan

From: Responding to COVID-19: how an academic infectious diseases division mobilized in Singapore

Workflows by sectorKey elements
Adult and children’s emergency department
 Assessment of patients with ARIScreening, clinical assessment, and risk stratification of COVID-19 suspects for admission versus “swab-and-go”
 Discharge of well patients with ARI (“swab-and-go”)Patient discharge criteria and advice with instructions for self-isolation, process for result notification, and return advice
 Notification and follow-up of patients “swab-and-go” resultsNotification of SARS-CoV-2 test result—automated messaging of negatives, phone notification by ID, and direct admission of positives
 Admission of family clusters with ARICoordinated workflow with medicine and pediatrics, including bed assignment for parents and children with suspect/confirmed COVID-19 to stay together
Ambulatory setting
 Assessment of outpatients with ARIScreening, clinical assessment, and risk stratification of COVID-19 suspects for referral to emergency department, direct admission to isolation or “swab-and-go” with special attention to routes dedicated for patient movement
 Screening of visitors to ambulatory centersSelf-declaration of symptoms and travel history, and thermal scanning of all visitors (and patients) with strict limit of 1 visitor per patient
Inpatient setting
 Admission to pandemic wardsAppropriate placement of suspect and confirmed cases based on risk and incremental surge isolation capacity to minimize nosocomial transmission risk and rationalize use of isolation rooms
 De-isolation of suspect and confirmed COVID-19 patientsAppropriate clinical assessment, as well as testing strategy (frequency and type of specimens) in relation to level of clinical and epidemiological suspicion before de-isolating patients, as well as discharging them home or to community isolation facilities
 Assessment of inpatients on non-pandemic wards with ARIClinical assessment and risk stratification to determine need for testing and transfer to pandemic ward
 Admission and management of suspect and confirmed COVID-19 cases in select patient populationsIndividualized workflows for immunocompromised hosts, pregnant women, patients requiring surgery or aerosol-generating procedures
 Critical care of suspect and confirmed COVID-19 casesProtocols, including PPE guidance, for patient requiring cardiopulmonary resuscitation, endotracheal intubation, tracheostomy, extracorporeal membrane oxygenation
Staff safety and management
 Assessment of staff with ARI with or without known workplace or community COVID-19 exposureRisk assessment and testing following staff exposure incidents based on PPE worn, procedure performed, duration, and proximity to patient
 Management of staff returning from overseas travelManagement of staff under quarantine order or stay-home notice
 Staff temperature surveillanceTwice-daily temperature checks and online recording in surveillance system
 Guidance on appropriate use of PPEGuidance on PPE according to clinical area and type of patient contact, including aerosol-generating procedures
  1. Abbreviations: ARI acute respiratory illness, SARS-CoV-2 severe acute respiratory syndrome coronavirus 2, PPE personal protective equipment