COVID-19 Clinical Updates

Contact

For non-emergent questions and concerns related to the virus:

< Back to COVID-19 landing page

March 22, 2020 UPDATE: The COVID-19 pandemic is spreading rapidly throughout the United States. We are also seeing broad PPE shortages. Envision and other contract management groups have developed collaborative guidelines in support of our clinicians. If you are an Envision clinician and have general questions about COVID-19, email Coronavirus@EnvisionHealth.com.

Wellness Resources

NEW! Wellness Resources for Clinical and Corporate Employees

Daily Clinician Support Meeting Invitation (.ics)

Key Take-Home Points

NEW! Envision has released guidelines regarding the use of face masks and eye protection for all patient encounters. N95s should still be used for all aerosolized procedures.

For clinician quarantines, use the Quarantine Intake Form on website.   

A COVID-19 email inbox (Coronavirus@EnvisionHealth.com) and a COVID-19 hotline (1.844.607.5824) have been established for non-emergency questions and concerns related to the virus.

Wellness resources are available on the website.

CONTENTS

  1. 1. The COVID-19 Pandemic
    1. 1.1 Situation
    2. 1.2 Background
    3. 1.3 Assessment
  2. 2. Recommendations
    1. 2.1 Healthcare Worker Quarantine Recommendations
    2. 2.2 Quarantine Considerations for Healthcare Providers with low staffing
    3. 2.3 Quarantine of an Envision Clinician
    4. 2.4 PPE
    5. 2.5 Volume Surges
    6. 2.6 Triage and Alternative Care Areas
    7. 2.7 Pre-Hospital Care
    8. 2.8 EMTALA
  3. 3. List Of All Resources

The COVID-19 Pandemic

Situation

The COVID-19 pandemic is spreading rapidly in the United States and around the world. New York and Washington State have significant levels of disease, and the virus continues to spread within all 50 states.

Extreme caution should be used when evaluating any patient, especially those with signs or symptoms of viral respiratory illness. We are closely monitoring developments to ensure we are keeping our patients and clinicians safe and informed with the most up-to-date information.

Background

The complete clinical picture for COVID-19 remains unclear, including the incubation period, times of infectivity and methods of transmission. Medical professionals appear to be particularly at risk for contracting the virus. Mortality rates have been shown to be around 1-2% in the general population, although the WHO has reported case fatality rates of 3.4% globally. Some countries, like Italy, are experiencing mortality rates greater than 5%. To date, testing for COVID-19 still is slowly beginning to expand. No vaccines or antivirals are available for this virus despite proclamations and limited studies of potential treatment options.

Assessment

Hospitals have seen significant increases in respiratory illness. We believe those cases will continue to rise over the coming weeks.

Treatment recommendations continue to be limited to supportive care measures. As the virus spreads, healthcare workers and hospital systems will need to frequently monitor their hospital’s infection control bulletins, the CDC’s website, Envision communications and local health department recommendations.

The Envision National COVID-19 Task Force will continue to release resources, guidance and communications as available.

Recommendations

Identification, Testing, treatment, Quarantine Protocols and Reporting
Below are general guidelines and recommendations. Continue to follow local guidance from your hospital or local health officials if available.

Healthcare Worker Quarantine Recommendations

Review CDC guidelines for quarantine and scenario-based recommendations for monitoring and risk categories of viral exposure for healthcare workers. Those who fall into a HIGH or MEDIUM risk category must remain out of work for 14 days and must be afebrile before returning. 
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

Quarantine Considerations for Healthcare Providers with low staffing

The CDC has recommended that “facilities could consider allowing asymptomatic HCP who have had an exposure to a COVID-19 patient to continue to work after options to improve staffing have been exhausted and in consultation with their occupational health program…Facilities could have exposed HCP wear a facemask while at work for 14 days after the exposure event.” https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

Quarantine of an Envision Clinician

Site clinical leaders (or site medical directors or chiefs) should complete the quarantine intake form at Envisionhealth.com/coronavirus or contact the Envision COVID-19 Hotline at 1.844.607.5824 if a physician or APP has mandated or self-directed quarantine.

PPE

Envision recommends the following PPE guidance:

  • Wear a surgical/procedure face mask and eye protection (face shield or goggles) for all routine (non-aerosol generating) patient encounters, if available
  • Wear a mask for the entire shift unless it becomes wet, torn or soiled
  • Wear a higher level of PPE (e.g., an N95 mask) for aerosol-generating procedures such as intubation, extubation, suctioning, etc. for undifferentiated respiratory failure patient
  • Clean plastic face shields and eye protection periodically and reuse after cleaning
  • Discard disposable face masks if a patient coughs or sneezes on the provider or if the clinician comes in contact with a high-risk COVID-19 patient
Volume Surges

Hospitals should plan immediately for significant increases in patient volume in the emergency department and medical inpatient units. https://annals.org/aim/fullarticle/2763037/how-should-u-s-hospitals-prepare-coronavirus-disease-2019-covid

  1. Develop a strategy for patient volume and complexity
  2. Identify alternative locations for staffing and triage of respiratory illness patients
  3. Develop surge staffing plans for the entire institution
  4. Protect and support our healthcare workers on the frontlines
  5. Define a strategy for limited healthcare resources
  6. Develop clear chains of command and open communication policies
Triage and alternative care areas

Hospitals and clinicians should ensure rapid triage and isolation for patients who screen positive as a PUI. Facilities should consider alternative treatment areas and modify emergency department intake/triage protocols. Telehealth solutions for patient triage should be employed where available to protect healthcare workers from exposure and mitigate volume surges.

Pre-Hospital Care

EMS workers or outpatient clinic providers should use personal protective equipment as described above and immediately inform the healthcare facility to prepare. Facilities should maintain a well-ventilated space, separated by six or more feet from other patients for incoming patients who screen positive as PUIs. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html 

EMTALA

CMS has clarified its statement regarding EMTALA regulations for COVID-19. Qualified RNs can perform a medical screen exam; however, check your hospital bylaws to determine if RNs are considered qualified to perform a medical screening examination at your facility. https://www.cms.gov/files/document/qso-20-15-hospitalcahemtala.pdf

The CDC’s guidance for treatment and evaluation is rapidly evolving. Continue to follow the CDC guidelines at https://www.cdc.gov/coronavirus/2019-ncov/index.html

All Resources

Health Department Lists

Local Health Department list State Department List

Personal Safety And PPE Guidance

Personal Checklist for Healthcare Providers PPE for Healthcare Personel Sequence for Putting on PPE Strategies for PPE Conservation from the CDC (webpage)

Patient Care Resources

Recommendations for Airway Management in a Patient with Suspected COVID-19 Perioperative Considerations COVID-19 CDC Home Care Guidance COVID-19 Flow Chart

Facility Resources

Emergency Physician and Midlevel Surge Capacity Protocol (ED & IPS) Hospital Preparedness Checklist CDC Healthcare Facility Checklist Hospital Access Example A Single Ventilator for Multiple Simulated Patients to Meet Disaster Surge

Quarantine

Quarantine Intake Form What Do I Do If I Am Quarantined At Home?

Envision Physicians' Leadership Articles

14 Ways Hospitals and Clinicians Can Combat the Coronavirus Pandemic - Dr. Adam BrownA Physician's Perspective on the Coronavirus - Dr. Adam Brown

COVID-19 National Resources

CDC COVID-19 Guidelines COVID-19 Clinical Resource and Research Database from The World Health Organization COVID-19 Global Case Tracker from Johns Hopkins University