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 sector | Key elements |
|---|---|
Adult and children’s emergency department | |
Assessment of patients with ARI | Screening, 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” results | Notification of SARS-CoV-2 test result—automated messaging of negatives, phone notification by ID, and direct admission of positives |
Admission of family clusters with ARI | Coordinated 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 ARI | Screening, 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 centers | Self-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 wards | Appropriate 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 patients | Appropriate 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 ARI | Clinical 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 populations | Individualized workflows for immunocompromised hosts, pregnant women, patients requiring surgery or aerosol-generating procedures |
Critical care of suspect and confirmed COVID-19 cases | Protocols, 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 exposure | Risk assessment and testing following staff exposure incidents based on PPE worn, procedure performed, duration, and proximity to patient |
Management of staff returning from overseas travel | Management of staff under quarantine order or stay-home notice |
Staff temperature surveillance | Twice-daily temperature checks and online recording in surveillance system |
Guidance on appropriate use of PPE | Guidance on PPE according to clinical area and type of patient contact, including aerosol-generating procedures |