Outpatient Site RN Phone Triage and Virtual Visit Scheduling for COVID-19

Agenda• COVID Hotline Number

• Pathway: Outpatient Settings

• Droplet and Contact Precautions

• RN Triage Guidelines

• Scheduling a Virtual Visit

• Virtual Visit Workflow

• COVID-19 Common Patient Questions

• Visitor Restrictions

• Resources

• Q&A

• Ensure patient keeps mask ON Provide routine care as indicated

• If pt. needs testing at other sites (cxr, lab etc.), call transferring site

• Instruct patient to inform Clinician if respiratory symptoms develop.

• Provide patient education: Recommend handouts from toolkit

COVID-19 Pathway: Outpatient Settings (Positive screen/Visit required)

(Physician Offices/Immediate Care (including radiology)/Urgent Care)

Identify Positive History

• Has patient had recent travel to high risk areas within 14 days? • Has patient had any close contact (within 6 ft.) to a laboratory confirmed COVID-19 person within 14 days of symptom onset? • Does patient present with fever or recent history of fever (Temp > 100.4°F or >38°C) and/or acute respiratory illness (i.e. new

or worsening cold like symptoms, influenza like illness symptoms, new or worsening cough, shortness of breath)?

Isolate & Prevent Transmission• Mask patient and anyone accompanying the patient• Communicate positive screening to clinical team member rooming patient• Immediately place patient and family members in exam room (if no rooms available, have pt. wait in car), keep door closed,

place signage on door and notify practice team

All Clinicians/Team Members Must Done PPE Before Entering The Room

• Procedure mask• Eye Protection (Mask/shield combo, Goggles, or face visor)

•Note: glasses are not adequate for eye protection

• Gown• Gloves

Created by: Advocate Aurora System and Medical Group Infection Prevention TeamCreation Date: 1/23/2020Revised Date: 1/24/2020; 1/27/2020; 1/28/2020, 1/30/2020, 1/31/2020, 2/3/2020, 2/5/2020, 2/27/20, 2/28/2020, 3/13/20

YES (to ANY of the above)

Evaluate for Testing

Clinical PresentationFever and/or signs/symptoms of lower respiratory illness (e.g. cough or shortness of breath)

ANDany of the following epidemiologic or other factors:

Contact TravelCongregated Living /

Healthcare FacilityMedical Health Concern

Public Health

ConcernAny person,

including health

care workers, who

has had:

• close

contact

with a

laboratory-

confirmed

COVID-19

patient

within 14

days of

symptom

onset

A history of travel

from affected

geographic areas

within 14 days of

symptom onset

The individual (staff and/or

patient/resident) is from a

congregate living or health

care facility:

• with clusters of

infection not due to

influenza and

suspected to be due

to COVID-19, as

determined in

collaboration with

public health

authorities

The patient is at higher risk for

complications from COVID-19 and for

whom rapid test results are more

likely to impact clinical

care/outcomes:

• older adults (age ≥ 65 years)

• chronic medical conditions

and/or an

immunocompromised state

(i.e. diabetes, heart disease,

receiving immunosuppressive

medications, chronic lung

disease, chronic kidney disease,

etc.)

Other situations involving

patients that clinicians

have thoroughly

evaluated and are

deemed:

• high priority after

consultation with

public health

OR

• are part of a

situation of

concern as

determined by

public health (e.g.

cluster of cases

from same venue)

Environmental Cleaning• Keep exam room closed for 2 hours prior to cleaning and disinfecting room• Don PPE prior to entering room• Wipe surfaces with approved disinfectant wipe: PDI Sani Cloth (Purple Top), ensure 2 minute contact “wet” time

Testing NOT Indicated

Clinician to contact Local Health Department to confirm criteria. If criteria met:

• Call ahead to emergency department or testing site to inform of pending patient arrival.

• Obtain instructions for where patient should go for testing.• Provide patient with mask and instruct patient to keep mask in place.

Site to notify: Infection Prevention (can call any IP on list)• Incident Command: 847-795-3930 (Leave message if no answer)

Testing Indicated = Inform

Patients who do NOT meet any of the above criteria for COVID-19 Testing by IDPH should be managed as clinically indicated

Process:

1. Print off signs (no need to be in color).

2. Place signs at PSR desk and some at nurses' station.

3. Patient requires a visit and answers yes to at least one of the screening questions.

4. Clinical team member comes to room patient.

5. PSR hands isolation sign to clinical team member.

6. Clinical team member places sign on door with tape.

7. Remove sign once patient has left and discard.

RN Phone Triage

Follow Normal Workflow

Patient Experiencing Symptoms

Patient states they have a Fever (T >100.4°F or >38°C)

and/or

Respiratory Symptoms (cough, shortness of breath)

Send call to an RN or Clinician (if RN is not available) stating:

“the patient states he/she is symptomatic AND has traveled to China, South Korea, Iran, or most of Europe or has had close contact

with an individual with confirmed COVID-19 within 14 days of symptom onset.”

Select Reason for Call of ‘EXPOSURE CORONAVIRUS (COVID-19) [1577]’

Obtain travel history and potential exposure history

History of travel from high risk areas within 14 days of symptom onset

Any person, including healthcare workers, who has had close contact with a laboratory confirmed COVID-19 patient within 14 days of symptom onset

OR

Yes No

No

If scheduling an appointment – MUST be GREATER than 14-

days. Document positive travel/exposure with no symptoms in

appointment notes. Ask patient to call back if they develop

symptoms prior to appointment.

If sending a message – select Reason for Call of ‘EXPOSURE

CORONAVIRUS (COVID-19) [1577]

Patient Experiencing Symptoms

Patient states they have a Fever (T >100.4°F or >38°C)

and/or

Respiratory Symptoms (cough, shortness of breath)

No

Patient Requests a Coronavirus Test

No

Use Scripting – No Testing Needed Without Symptoms

“Since you are not experiencing symptoms, there is no

indication that you need testing. If symptoms develop, please

call back for further screening.”

Refer to Illinois Department of Public Health for

Additional Information

“For additional information on Coronavirus, call the Illinois

Department of Public Health FAQ line 1-800-889-3931 or

visit dph.Illinois.gov”

Offer AAH website

https://www.advocateaurorahealth.org/coronavirus-disease-

2019?_ga=2.6808626.1224959309.1584032911-

107482052.1529006377

and Coronavirus

Visit the CDC website at cdc.gov/coronavirus/2019-nCoV

COVID-19

Appointment/Sick/Testing Calls received by the Practice Site

Route to Clinical Licensed Team Member

Is there a clinically licensed individual team member available in the department for the assessment?

YesNo

Warm transfer patient to COVID-19 Hotline: 866.443.2584

Yes

Go To Nursing FlowCreated by: Advocate Contact CenterCreation Date: 3/13/20 PAGE 1 / 2

Yes

Yes

CLOSE CONTACT is living in the same house with a person with

confirmed, probable, or suspected coronavirus. OR within 6-feet

of a person with confirmed, probable, or suspected coronavirus

(kissing, hugging, sharing eating utensils, carpooling, close

conversation)

Close Contact is NOT being in same school, church, workplace,

community

Needs Further

Assistance

Created by: Advocate Contact CenterCreation Date: 3/13/20

RN or Clinician reviews patient symptoms and confirms travel history

Is patient in respiratory distress?

If calling 911

for the patient,

the caller

should inform

911 that

patient is

symptomatic

with a positive

travel screen

for COVID-19.

Advise patient

to call 911 and

inform the

dispatcher that

they are

symptomatic

with positive

travel screen

for COVID-19.

Yes No

PAGE 2 / 2

Clinician Assesses Patient With Coronavirus (2019-nCoV) Exposure to Disposition

Applies Coronavirus (2019-nCoV) Exposure or Clinical Judgement

Dispositions Virtual Visit

Schedule the patient for a Virtual Visit at least 30 minutes out

from time of call

• Visit Type: 7450 COVID-19 HEALTH SCREENING

[7450]

• Use provider/resource - C19 VIRTUAL HEALTH

SCREENING [202786] and uncheck Auto-Search when

looking for availability.

• Ensure patient has access to portal already. If not, send

them an activation email.

• If patient DOES NOT have technology for Video,

document phone number to contact patient at in

Appointment Notes – “No MyChart: Call patient at xxx-

xxx-xxxx”

• Inform patient to look for an email from Zoom and follow

the instructions for your scheduled virtual visit. Please log

in 15 minutes prior to your appointment.

Follow Job Aides for Portal Account and Scheduling

accordingly.

Dispositions

Home Care

⁻ Provide

reassurance and

home care.

Dispositions with Emergency Department

1. RN to call the local health department for review and direction for

novel coronavirus (COVID-19). Illinois Local Health Department

Communicable Disease Telephone Numbers

- If health department does not answer/reply within 45-min – call

AMG Infection Prevention Mon-Fri 8am-5pm AMG Infection

Prevention Team Contact Information.docx

2. Health department recommendations that this patient:

a) Does Not meets criteria, follow their recommendations for next

steps with patient.

b) Does meet criteria, proceed to next step with notification to ED.

⁻ The RN calls the ED to let them know that a symptomatic

patient with a positive travel screen for novel coronavirus

(COVID-19) is being sent to the ED for further evaluation and

specimen collection.

⁻ Have ED clarify location that patient should go once they

arrive at the ED. Inform ED that this patient is coming from

home and will need to get a mask once they arrive to the ED.

Communicate instructions to the patient.

⁻ RN informs the symptomatic patient with positive travel screen

for novel coronavirus (COVID-19) to put on a mask

immediately upon arrival.

Patient has already tested

for Coronavirus (positive,

negative, or pending)

Symptoms are Same or

Better:

⁻ Provide reassurance and

home care.

⁻ For pending results – RN to

send provider’s clinical

support pool a message with

testing location and details

⁻ For newly confirmed

positive results – RN to call

IDPH for further instructions

Initial Assessment QuestionsPLACE of CONTACT: "Where were you when you were exposed to coronavirus?" (e.g., city, state, country)

TYPE of CONTACT: "How much contact was there?" (e.g., live in same house, work in same office, same school)

DATE of CONTACT: "When did you have contact with a coronavirus patient?" (e.g., days)

SYMPTOMS: "Do you have any symptoms?" (e.g., fever, cough, breathing difficulty)

PREGNANCY OR POSTPARTUM: "Is there any chance you are pregnant?" "When was your last menstrual period?" "Did you deliver in the last two weeks?“

HIGH RISK: "Do you have any heart or lung problems? Do you have a weakened immune system?“ (e.g., CHF, COPD, asthma, HIV positive, chemotherapy, renal failure, diabetes mellitus, sickle cell anemia)

Virtual Visit Disposition[1] Fever or feeling feverish AND [2] within 14 Days of CORONAVIRUS EXPOSURE.

[1] Cough occurs AND [2] within 14 days of CORONAVIRUS EXPOSURE.

[1] Fever or feeling feverish AND [2] symptoms of lower respiratory illness (e.g., cough, difficulty breathing) AND [3] TRAVEL TO HIGH RISK AREA PER CURRENT CDC GUIDELINES within last 14 days.

[1] Body aches, chills, diarrhea, headache, runny nose, or sore throat occur AND [2] within 14 days of CORONAVIRUS EXPOSURE.

[1] Fever or feeling feverish AND [2] within 14 Days of CORONAVIRUS EXPOSURE

1. Schedule Virtual Visit

2. Isolation Is Needed:

• Isolate yourself at home.

• Do Not allow any visitors

• Do Not go to work or school

• Do Not go to church, childcare centers, shopping, or other public places.

• Do Not shake hands.

• Avoid close contact with others (hugging, kissing).

3. Cover Your Mouth and Nose, Wear a Mask:

• Cover your mouth and nose with a disposable tissue (e.g., Kleenex, toilet paper, paper towel) or wash cloth.

• Ask for a mask to wear over your mouth and nose.

4. Wash Your Hands with Soap and Water:

• Wash your hands and face frequently with soap and water.

5. Fever Medicines*:

• For fever relief, take acetaminophen or ibuprofen.

• Treat fevers above 101° F (38.3° C).

• The goal of fever therapy is to bring the fever down to a comfortable level. Remember that fever medicine usually lowers fever 2-3° F (1-1.5° C).

6. Call Back If:

• Breathing difficulty develops

• You become worse.

7. Care Advice given per Coronavirus (2019-nCoV) Exposure (Adult) guideline.

*Specific dosing and caution statements provided in full guidelines

R/O: Coronavirus. Reason: Meets PUI criteria (patients under investigation). Note: Typically, the fever is greater than 100.4F (38.0 C). However, people who are elderly or have a weak immune system may not have a significant fever.

Home Care Dispositions[1] CORONAVIRUS EXPOSURE within last 14 days AND [2] NO cough, fever, or breathing difficulty.

[1] TRAVEL FROM A HIGH-RISK AREA PER CURRENT CDC GUIDELINES within last 14 days AND [2] NO cough or fever or breathing difficulty.

[1] CORONAVIRUS EXPOSURE 15 or more days ago AND [2] NO cough or fever or breathing difficulty.

[1] CORONAVIRUS EXPOSURE within last 14 days AND [2] NO cough, fever, or breathing difficulty

Note to Triager - Should the Patient Go to Work?

• It is reasonable for people who have traveled from a high-risk area per current CDC guidelines or had close contact

exposure to coronavirus in the last 14 days, to make arrangements to work from home until 14 days have passed.

• The patient should talk to the occupational health office for their workplace.

Reassurance and Education:

• Although you were exposed to Coronavirus, it appears that you do not currently have any symptoms of coronavirus

infection. Coronavirus infections starts within 14 days following the last exposure. Since it's been less than 14 days,

you still are at risk for getting sick with coronavirus.

• You need to watch for symptoms until 14 days have passed.

• Limit close contact with others for at least 14 days from last exposure

Coronavirus Outbreak:

• Currently, limited information is known about this novel (new) coronavirus respiratory infection.

• An outbreak of this infection began in Wuhan, Hubei Province, China in December 2019.

• The first patient in the United States occurred on January 21, 2020.

• This is a new and rapidly changing situation.

Coronavirus - Symptoms:

• The coronavirus can cause a respiratory illness, such as bronchitis or pneumonia.

• The most common symptoms are cough, fever, and shortness of breath.

• Other symptoms are body aches, chills, diarrhea, fatigue, headache, runny nose, and sore throat

Reason: People exposed to coronavirus but without symptoms should be followed closely by a health care provider.

[1] CORONAVIRUS EXPOSURE within last 14 days AND [2] NO cough, fever, or breathing difficulty – Cont’d

Coronavirus - Exposure Risk Factors:

• Exposure to a person who has been diagnosed (laboratory confirmed) with coronavirus.

• Travel from an area with recent local transmission of coronavirus, such as China.

• The CDC (www.cdc.gov) has the most up-to-date list of where the coronavirus outbreak is occurring.

Measure Temperature:

• Report any fevers to your health care provider or to the local department of public health.

• The patient should check their temperature two times a day. Early detection of symptoms is the only way to prevent spread of the

disease.

Isolation is Needed If Fever or Other Respiratory Symptoms Occur:

• Isolation will be needed if you develop a cough or fever within 14 days of coronavirus exposure:

• Isolate yourself at home.

• Do Not allow any visitors

• Do Not go to work or school

• Do Not go to church, childcare centers, shopping, or other public places.

Call Back (or Call Your Doctor) If:

• Fever or feeling feverish occurs within 14 days of coronavirus exposure.

• Cough or difficulty breathing occur within 14 days of coronavirus exposure.

• Body aches, chills, diarrhea, headache, runny nose, or sore throat occur within 14 days of coronavirus exposure.

• You have more questions.

Care Advice given per Coronavirus (2019-nCoV) Exposure (Adult) guideline.

Additional Resources Within Guidelines

• Definition of ‘close contact’

• Key information for patients calling 911/going to ED

• Information for patients regarding:

• Coronavirus Outbreak

• Symptoms

• Exposure Risk Factors

• How it is Spread

• How to Protect Yourself From Getting Sick

• Travel recommendations

Scheduling a Virtual Visit

Virtual Visit Scheduling Verbiage

When patients need to schedule a virtual visit

• DO schedule a virtual visit in the NEXT AVAILABLE opening (no matter what time it is).

• DO inform patients to expect a call from a care provider in the next 12-24 hours.

• DO include patient’s telephone number in the Appt Notes.

• DO SAY: “I have arranged for you to have a virtual visit with a healthcare provider. You can expect someone to call you back within the next 12-24 hours. Our providers are working hard to ensure everyone gets the care that they need. They will call your phone number directly as soon as they are available.”

• DO NOT provide patient a set time for a call back.

When patients call to state they have not yet had their virtual visit

• DO go to the Appt Desk to confirm that the patient has an upcoming appointment for a Virtual Visit with the C19 VIRTUAL HEALTH SCREENING [202786] resource provider.

• DO tell patients that you see they are scheduled for a virtual visit and that the provider will call them within the next 12-24 hours.

• DO SAY: “I can confirm that we have you in the queue for a virtual visit. Our care providers are working hard to ensure everyone receives the care they need. You can expect someone to call you directly in the next 12-24 hours.”

Virtual Visit Workflow

COVID - Virtual Health Visit Patient Has Other Health Issue To Address

Virtual Visit by

APN

Travel or Exposure?

Respiratory Symptoms?

NegativeAnother

Health Issue Be

Addressed?

Negative

Message provider’s clinical support pool – for site to contact the patient to schedule an appointment.

This patient was appropriately triaged through the Virtual Health Covid-19 Screening process and evaluated by an APN. The patient has screened negative for travel or exposure. Determination was made that the patient does need to be evaluated in clinic. Please contact the patient to schedule an appointment.

Message provider’s clinical support pool – for site to contact the patient to schedule an appointment.

This patient was appropriately triaged through the Virtual Health Covid-19 Screening process and evaluated by an APN. Determination was made that the patient does need to be evaluated in clinic. Because the patient has screened positive for travel and/or exposure to Covid-19, please be aware that appropriate precautions need to be taken as per current recommendations (example: mask before entering clinic). Please contact the patient to schedule an appointment.

Respiratory Symptoms?

Positive NegativeAnother

Health Issue Be

Addressed?

COVID-19 Common Patient Questions

COVID-19 Testing FAQ• Patients must have a provider order to be tested for COVID-19.

• Screening is done via hotline/virtual visit.

• Exploring orders placed by Primary Care sites.

COVID-19 Testing FAQQ: Can I get a test at my doctor's office?

A: “No. We are not offering tests at non-hospital locations.”

Q: Why not?

A: “Per the CDC recommendations, patients with symptoms should first be screened through social distancing techniques (via phone and virtual visits) to limit exposure for our vital team members at the site and patients with non-COVID needs.”

Q: I heard on the news that there are no restrictions on who can get a test.

A: “Though the news is reporting this, it is not entirely true. The CDC guidelines first require that you are positive for symptoms and exposure before testing is advised.”

COVID-19 Exposure FAQQ: I was in the same building as someone who tested positive for COVID-

19. What should I do?

A: “The CDC indicates that being in the same building is not considered close contact.”

Q: What counts as close contact?

A: “Close Contact to coronavirus is defined as:

• Household Close Contact: Living in the same house (household contacts) with a person with confirmed, probable, or suspected coronavirus.

• Other Close Contact: (within six feet, two meters; touching distance) with a person with confirmed, probable, or suspected coronavirus. Examples of such close contact include kissing or hugging, sharing eating or drinking utensils, carpooling, close conversation, performing a physical examination (relevant to health care providers).”

COVID-19 Patient Appointment FAQ

Q: I have an upcoming appointment with my doctor. Should I reschedule given the COVID-19 situation?

A: If you have an appointment within the next 30 days reach out to your provider to verify if you should come in for your appointment. Each clinic is reviewing schedules to determine which patients can be seen virtually or rescheduled versus those that need to be seen in person.

Q: Can patients with flu-like symptoms be directed to the ACW or ICC?

A: “No, we first want to screen you over the phone or through a virtual visit to limit exposure to other patients and healthcare providers at the ICC or ACW.”

COVID-19 Mask FAQQ: Should I wear a mask to protect myself against COVID-19?

A: “No. Only those with symptoms or caring for someone with symptoms (healthcare workers) are recommended by the CDC to wear a mask. Most masks that are available to the public are not custom-fitted to the wearer, which means that coronavirus can get in through gaps. The CDC recommends masking individuals with symptoms to prevent the spread ofCOVID-19.”

COVID-19 Public Safety and Preparedness FAQ

Q: Should I stock up on prescription medications?

A: The CDC recommends that high-risk patients stock up on household items (including medications) so that you are prepared to stay home for a period of time. Visit the CDC website at CDC.gov/coronavirus for regularly updated information.

Q: Am I at risk for COVID-19 from a package or goods shipped from China?

A: The CDC indicates that there is currently no evidence to support transmission of COVID-19 on imported items and there have not been any cases in the United States associated with imported goods.

Q: I heard sunlight kills COVID-19. Is that true?

A: At this time, the CDC does not have enough information on COVID-19 to understand if the spread of COVID-19 will decrease when it becomes warmer. Visit the CDC website at CDC.gov/coronavirus for regularly updated information.

Visitor Restrictions• AMG initiatives

• Students

• Current inpatient policy

ResourcesCoronavirus COVID-19 Information Center

Questions?

Wrap Up