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FIGURE 1: TRIAGE CATEGORIES PAT I EN T M EETS C R I TE R I A FO R H I TH A DM I SS I O N
GREEN
AMBER
RED
Asymptomatic
Low risk category in danger zone (day 5–11) of illness
Shortness of breath
OR Mild symptoms (runny nose, cough, sore throat, myalgia, fatigue)
Low risk category with multiple symptoms
EXCLUSIONS
OR
High risk category
High risk category past danger zone and with only mild symptoms/signs
Fever Shortness of breath Moderate or severe disease or complicated illness course (transfer to hospital)
HIGH RISK > 60 years of age Prescence of co-morbidities (especially asthma) Anyone in whom there is clinical concern LOW RISK
< 60 years of age Mild URTI symptoms only No major co-morbidities
minimal symptoms and had received medical clearance from DHHS. EVOLUTION OF THE PROGRAM The program evolved to meet increasing demand. In the beginning, all admissions were made by the newly appointed HITH general practitioner (GP) and all reviews by the HITH program coordinator. As admissions rapidly increased, HITH staffing was augmented by nurses redeployed from elsewhere in the health service, such as theatre. To improve patient safety, a ‘traffic light’ triage system of patient risk assessment was developed. Referrals were triaged by the HITH program coordinator using the triage tool to assign a risk category to the patient. Consultations were then tailored to the risk rating. Red and amber category patients received at least twice daily phone reviews and regular
OR
OR
High risk category in danger zone EXCLUSIONS High risk category AND shortness of breath (transfer to hospital) Moderate or severe disease or complicated illness course (transfer to hospital)
CRITERIA FOR HITH ADMISSION • • • • •
Clinically stable Home is safe Has telephone Patient consent Appropriate infection control at home is possible
consults with the GP. Green category patients received daily reviews with a nurse. See fig.1: Triage categories Experience soon showed that patients who deteriorated did so between day five to 10 of their illness, especially if there was pre-existing asthma. The protocols were adjusted so that between day five to 10, green zone patients may be moved to the amber zone, depending on their symptoms, while amber and red zone patients had an increase in the frequency of their observations and clinical reviews. An escalation protocol, triggered by specified clinical conditions or alteration in clinical parameters, was developed and aligned to the track and trigger clinical deterioration tool used in the health service. The protocol involved the nurse escalating any deterioration to the medical staff for patient review. At this point,
• Independent with ADLs or has carer • Can self-monitor and understands when to call for help • Preferably not living alone
options included an urgent GP telehealth consultation, transfer to Urgent Care for a physical assessment, or immediate transfer via ambulance to a tertiary hospital. See fig. 2: Clinical deterioration protocol Although the program was able to be led and operated by only nurses, a generalist doctor helped by providing care for patients’ multi-faceted medical issues (such as COVID-related symptoms and complications, chronic disease issues and mental health problems) and by helping to discriminate which deteriorating patients warranted transfer to hospital. Nurses were able to discharge green zone patients who met discharge criteria. Red and amber zone patients were discharged by the GP. A DHHS clearance certificate, which may be issued after discharge from HITH, was required before patients could leave quarantine.
Apr–Jun 2021 Volume 27, No. 3 37