Covid-19 BOP Community Care Clinician Guide_V1 251121

A guide for primary care clinical management of COVID19 in the community For Bay of Plenty General Practice Providers

Version One

Version One. 25 November 2021.

1

A guide for primary care clinical management of COVID19 in the Community Contents Overview ................................................................................................................................................... 3 Contact Numbers ...................................................................................................................................... 4 The BOP COVID-19 Community Case Management in Adults Model....................................................... 5 Clinical Assessment and Risk Stratification ............................................................................................. 10 Initial assessment (part 1) checklist .................................................................................................... 11 Initial Assessment (part 2) Baseline clinical information .................................................................... 12 Initial Assessment (part 3) Risk Stratification questions to determine level of care .......................... 13 Ordering and Delivery of Pulse Oximeters.............................................................................................. 16 Ongoing Assessment ............................................................................................................................... 17 Daily Symptom Checklist (for duration of care) .................................................................................. 21 Referring to Hospital Care....................................................................................................................... 22 End of Life Care TBC ................................................................................................................................ 23 Access to syringe driver TBC ................................................................................................................... 23 Access to Oxygen TBC ............................................................................................................................. 23 Funding ................................................................................................................................................... 23 Appendix 1: Guide to Models of Care ..................................................................................................... 25

Version One. 25 November 2021.

2

Overview This guidance document provides an overview of the primary care led clinical model for patients with COVID-19 in the Bay of Plenty. This is a compilation of both national and regional guidance that has been localised for the Bay of Plenty. It will be continuously updated as more information comes to light.

This guide, and it’s updated versions, will be available for download on the PHO Covid Portal Page http://portal.wboppho.org.nz/covid-19/ Content for this guidance document has largely been drawn from the COVID-19 Case Management in Adults pathway provided on the Midland Health Pathways portal.

This pathway can be accessed here: https://midland.communityhealthpathways.org/728651.htm Username: midlanduser Password: midlandpassword

The community care, welfare, home and community, mental health and disability support needs of the household/whānau are organised alongside the COVID-19 Primary Care Clinical Model. This organising function is in the form of a community ‘hub’ for health and social supports managed through the DHB. This COVID-19 Case Management in Adults pathway is the current version that general practice teams in the Auckland region are using to manage COVID-19 patients in the community.

Clinical expertise and capacity in the primary care sector is utilised to keep people well in their homes (where appropriate to do so) and reduce demand on secondary care resources (eg. hospitals). The model focuses on reserving specialist resources in primary and secondary care to manage complex conditions and cases.

The Ministry of Health is leading the ongoing development of this pathway. Work to date has been informed by overseas models such as the RPA Virtual Hospital in NSW Australia and Ontario Canada, and local models (NRHCC, CDHB, SDHB) across New Zealand.

The BOP DHB continues to work with the Ministry of Health on the supporting resources, timing, and processes required to adapt this pathway for our region’s local needs.

Consequently, it is expected this guidance document will either be shortly replaced by a national Ministry of Health guide, or continuously updated as more information comes to light.

Key websites to refer to for updates are: Midland Community Healthpathways https://midland.communityhealthpathways.org/728651.htm Ministry of Health https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novelcoronavirus/covid-19-information-health-professionals/covid-19-primary-care

Version One. 25 November 2021.

3

Contact Numbers These numbers are for clinical teams only, not to be shared with patients.

Public Health – Toi Te Ora TTO IMT Clinical Case Advisor TTOCRG-clinicalcaseadvisor@bopdhb.govt.nz If primary care has questions call Toi Te Ora on 027 336 9159 depending on urgency.

Welfare: TTOCRGSIQWelfare@bopdhb.govt.nz 027 304 9423

PHO Covid Primary Response Team (CPRT) (for support on the clinical management of patients in the community) Email: cprt@healthbop.org.nz Phone: (07) 577 3234

Community Hub (for all welfare and social needs support) Contact details yet to be confirmed

EBOP Coordination Hub (for clinical, welfare and social need support) EBOPcovid@bopdhb.gov.nz Phone: 021606674

Specialist Clinical Advice or Secondary Care Referral For urgent advice contact the on call medical SMO via switchboard WBOP 07 579 8044 For non urgent virtual advice contact the same service: on call medical SMO via switchboard WBOP 07 579 8044 National Telehealth Service for health professionals on 0800-177-622 Monday to Saturday 8 am to 7 pm.

Version One. 25 November 2021.

4

The BOP COVID-19 Community Case Management in Adults Model

Pathlab notifies both Toi Te Ora AND the patient’s GP of a positive case Toi Te Ora: -

Not safe to isolate at home

- Notifies Patient they are positive Safety Assessment and Contract Tracing - Identify where patient will isolate

CIQ

Safe to isolate at home Refer to Covid Primary Response Team to co-ordinate clinical response

Refer to Community Hub to co-ordinate welfare care

In EBOP the clinical and welfare response will be coordinated by Quay Street Community Hub

General Practice undertakes Initial Virtual Assessment.

10-14 days, provided the previous 72 hours are symptom free

Identified as Level 1 (Asymptomatic / Mild), Level 2 (Moderate Symptoms / At risk of complications)

Level 1: regular virtual health check

Refer to hospital if High Risk

Level 2:Regular more frequent virtual health check, supported by multi-disciplinary team.

Patient sent information pack and pulse oximeter and/or welfare supports if applicable.

Discharge and Follow Up Version One. 25 November 2021.

5

Process for COVID-19 patient care in the community The current process is for people with COVID-19 to be cared for in a Community Isolation and Quarantine (CIQ) facility, or in the community (either at home or a temporary accommodation) under Community-supported Isolation and Quarantine (C-SIQ).

Positive Test Result and Public Health Role •

When a person tests positive for SARS-CoV-2, the lab notifies Public Health and the patient’s GP.

•

Public Health then: •

contacts the patient to assess their public health risk, initiate contact tracing and decides if the patient can isolate at home under C-SIQ or needs to go to an CIQ facility.

•

makes a manaaki/welfare referral to the Community Hub if required, e.g. for food, care of pets, mental health and disability support.

•

refers the patient to the CPRT to coordinate their clinical review if they are remaining in the community.

Community Management – Covid Primary Response Team (CPRT) •

The CPRT will contact the practice where the patient is enrolled, or identify a service who can deliver care to a patient that is not enrolled locally, to initiate the virtual clinical assessment process

•

Ideally, patients will be cared for by their usual primary care practitioner. Where this is not possible an alternative provider will be identified for their covid related care.

Where there are multiple patients isolating at the same address a single provider will be identified, where possible, to ensure continuity of care to the household.

•

Following virtual assessment the practice will send an email to the CPRT confirming the Provider delivering care, the Level of Care (1 or 2), and whether a pulse oximeter is required. Note, a practice can report Shared Care if they are running a daily Doctor on Duty model.

•

The CPRT will co-ordinate delivery of the pulse oximeter to the patient if required.

Version One. 25 November 2021.

6

Community Management - Practice Role •

Following referral from the CPRT, the practice starts the process of regular clinical review of patients who can safely isolate at home or in temporary accommodation.

•

Ideally the initial assessment should be undertaken by an NP or GP, ongoing assessment can be delegated to the nursing team with NP/GP oversight as required.

•

Clinical care and assessment tools, based on Midland HealthPathways are provided in this document.

•

Inform the CPRT team via email confirming the Provider delivering care (this could be a shared care model), the Level of Care (1 or 2), and whether a pulse oximeter is required.

•

Patients identified over the weekend will be managed by an alternate provider until formal handover can be made.

•

Weekend review of known patients should ideally be managed by the practice.

Where this is not possible care will need to be handed over to an alternate provider (details on this process TBC)

•

If your patient is also under the care of other services, eg Hospice, District nursing please can you let these teams know, where possible.

•

If you suspect the patient is not known to Public Health (or has not yet been contacted by Public Health) advise patient and their household to self isolate immediately while waiting for input from Public Health staff and Contact Public Health.

•

If you identify unmet social or welfare needs, contact the Community Hub.

•

Ensure the patient has been provided with the Covid Community Care Patient handbook - can be sent electronically or from the Community Hub.

•

For non urgent virtual advice contact the on call medical SMO via switchboard WBOP 07 579 8044

Discharge from Hospital Care 1. Following hospitalisation with COVID-19 a patient may be discharged back into community self isolation to complete their recovery. The hospital will inform Public Health and the CPRT at discharge. The CPRT will liaise with the relevant general practice to ensure ongoing care in the community.

Version One. 25 November 2021.

7

2. These patients are automatically COVID-19 Care 2 for the remainder of their review period. The referring clinician will advise where the patient is in their illness. ToC is done at discharge, the patient will have a copy and the GP will be sent this electronically. Patient’s will also be provided with information packs for community care at point of discharge.

3. Recommend that unvaccinated or partially vaccinated patients have COVID-19 vaccination 4 weeks after recovery or, asymptomatic patients have vaccination 4 weeks after the first confirmed positive COVID-19 test, unless contraindicated. a. The duration of protection from COVID-19 infection is unknown. b. It is uncommon to become re-infected with COVID-19 within 6 months of infection, and the risk is further reduced by vaccination.

Release from Community Monitoring Patients are cleared for release from self-isolation by the team providing their community management care, once they have met the relevant criteria. For: • •

Fully vaccinated cases, the isolation time is 10 days, provided the previous 72 hours were symptom free.

Unvaccinated cases, the isolation time is 14 days provided the previous 72 hours were symptom free.

The counting of the days starts from the day of diagnosis which is day 0.

Day 0 is the first day of symptoms, or day when positive covid test was done, whichever comes first.

The handover from public health will include day 0 date for each case.

Please inform your local Covid Primary Response Team when cases are released. They will then coordinate with Public Health who will update the National contact tracing system.

Any queries about release from community management should be directed to Public Health.

Please also inform To Te Ora if there are any public health concerns, i.e. compliance issues, questions about isolation/testing.

Release from Isolation If there are others in the house also self-isolating then there is an additional 10 days self isolation at the end of the recovery time of the positive case to ensure no new positive

Version One. 25 November 2021.

8

cases develop amongst the household. The recovered patient has to remain in isolation throughout this time as well.

There may be instances where people are isolating in the same ‘household’ but doing so in complete isolation from the case. In this scenario, the additional 10 days isolation does not apply.

•

An example where this might apply would be if they live on a farm and the household close contact is isolating in a separate building to the case. Everyone will need to follow public health advice to make sure there is absolutely no contact with the case(s) till case(s) are recovered.

Household contacts only have to isolate from their last exposure day and they require 10 days isolation and a swabbing regime which is immediate, day 5 and day 8.

From a contact tracing perspective, Toi Te Ora do their best to complete a thorough investigation over multiple phone calls but there are instances when cases remember more/new details regarding where they have been. If cases are report that they have been somewhere while infectious, and they forgot to tell public health during our interviews, please inform Toi Te Ora, generally via the email above. Call if deemed urgent, or high risk places. i.e. high risk places: hospitals, prisons, age care facilities etc.

Long term Management Following Covid Infection Long term care following Covid-19 infection is not covered within this guide.

It is recommended that any patient who required hospital admission has a telephone or inperson follow-up within 6 weeks of discharge for patients to assess trajectory of recovery.

Version One. 25 November 2021.

9

Clinical Assessment and Risk Stratification This pathway is about remote clinical assessment of patients with COVID-19 aged 15 years or older who are isolating in the community, where the primary care team has accepted handover of clinical care via Public Health and the Covid Primary Response Team (CPRT).

Welfare needs will be addressed by the Covid Co-ordination Hub. 1.

2.

3.

4.

Determine any Red Flags for ED Assessment Remote Consult Check List information and Stratification Questions (Part 1,2, 3) Assess Clinical Risk Assess whether non COVID-19 health care and social supports have been addressed. This is managed by the Covid Community Hub 5. Liaise with public health and secondary care as needed See footnote1 for guidance on in-person assessments.

Red flags for ED Assessment • HR >110, SPO2 consistently ≤ 92%, RR >24 • Severe shortness of breath at rest (e.g. Breathlessness RR >30 despite normal O2 sats) • Difficulty in breathing (work of breathing) • Reducing O2 saturation (<92% or down 3%) • Pain or pressure in chest • Decreased oral intake or urine output (dehydrated, needing IV fluids) • Cold, clammy or pale mottled skin • New onset of confusion, becoming difficult to rouse, syncope • Blue lips or face • Coughing up blood Arrange acute COVID-19 assessment if escalation to hospital care is required, including assessment for any non-COVID condition.

1

In-person assessments. Based on overseas experience, in-person assessment is not usually required to decide management, and is only indicated: if it will change management, or when the treating clinician is not confident they can adequately assess the patient remotely. Consider in-person assessment when escalating to hospital care.

The key elements of an in-person assessment are: 1. taking the history by phone to limit contact, 2. preparing for in-person examination, using: space for examination with good airflow; full personal protective equipment (PPE) and infection prevention and control (IPC) measures; key equipment – pulse oximeter, a thermometer, blood pressure (BP) cuff, and stethoscope.

Version One. 25 November 2021.

10

Initial assessment (part 1) checklist

Version One. 25 November 2021.

11

Initial Assessment (part 2) Baseline clinical information

Version One. 25 November 2021.

12

Initial Assessment (part 3) Risk Stratification questions to determine level of care

Version One. 25 November 2021.

13

Version One. 25 November 2021.

14

Assess Clinical Risk The clinical risk profile of an individual is determined by their individual clinical risk and the most vulnerable/at-risk member of their household.

COVID-19 Care 1 if the patients answers no to all of the stratification questions and there are no high-risk household members2 (whether COVID-19 positive or negative).

COVID-19 Care 1 Patients self-monitor symptoms daily and receive alternate day (or as clinically indicated) remote clinical assessment from an appropriate practitioner. This can be a nurse, NP or GP (if this is provided by a nurse, then NP or GP support must be available if required) COVID-19 Care 2 if they answer yes to any of the stratification questions or there are any high-risk household members (whether COVID-19 positive or negative).

COVID-19 Care 2 Most patients in COVID-19 Care 2 have risk factors putting them at higher clinical risk of deterioration and requiring daily monitoring.

Ask the patient to self-monitor (including pulse oximetry if required) and record observations at least twice daily.

Higher risk patients are reviewed by a suitable clinician daily (including weekends), with additional checks as clinically indicated. Patients should have access to a pulse oximeter if they have personal risk factors for COVID-19 Care 2.

A patient with a clinically lower risk may be stratified to COVID-19 Care 2 due to having a high risk household member. Stratification to COVID-19 Care 2 indicates clinical risk of deterioration if the household member becomes COVID-19 positive and therefore a need for awareness of the household.

Arrange a pulse oximeter. Patient Instructions for use can be found here (and will be supplied with the pulse oximeter to the patient) https://www.healthnavigator.org.nz/health-a-z/p/pulse-oximeter-adult/ Ensure contactless delivery from pharmacies is available if needed.

High-risk household members: The patient with COVID-19 can usually identify high-risk household members quickly if asked about the age of household members, whether any are not vaccinated, and if any have medical conditions.

2

Version One. 25 November 2021.

15

Risk Stratification tool to assess level of care

Seek COVID-19 advice: •

if patient is stratified to COVID-19 Care 2 but cannot access a pulse oximeter.

•

if uncertain about management.

•

about appropriate investigation and venue if other investigations are required.

Ordering and Delivery of Pulse Oximeters Email or phone the Covid Primary Response Team cprt@healthbop.org.nz (07) 577 3234 with the pulse oximeter request, following the virtual assessment.

Note: Toi Te Ora may identify the need for a pulse oximeter at first point of contact with the patient, in which instance they may provide this information to the CPRT at point of referral, the CPRT will then organise the pulse oximeter delivery at this earlier stage.

Please inform the CPRT if there are any changes to patient call phone number or address for pulse oximeter delivery.

The CPRT will then submit the pulse oximeter request to the DHB team.

The pulse oximeter will be delivered to the patient, they will arrive with the pulse oximeter, put the oximeter on the ground in front of the door and knock on the patient’s door, then stand back to speak to the patient – just to let them know that the oximeter is there. If they have trouble locating the address or if no one answers the door they will phone the patient.

Version One. 25 November 2021.

16

Ongoing Assessment Establish what day this is in the course of the patient's COVID-19 illness and continue the clinical review cycle until at least day 10.

The counting of the days starts from the day of diagnosis which is day 0.

Day 0 is the first day of symptoms, or day when positive covid test was done, whichever comes first.

For vaccinated cases, the isolation time is 10 days, provided the previous 72 hours were symptom free.

Unvaccinated cases, the isolation time is 14 days provided the previous 72 hours were symptom free.

The handover from public health will include day 0 date for each case.

Clinical review cycle •

At COVID-19 Care 1, patients self-monitor symptoms daily and receive alternate day (or as clinically indicated) remote clinical assessment from an appropriate practitioner. This can be a nurse, NP or GP (if this is provided by a nurse, then NP or GP support must be available if required).

•

At COVID-19 Care 2: •

higher risk patients are reviewed by a suitable clinician daily (including weekends), with additional checks as clinically indicated. Patients should have access to a pulse oximeter if they have personal risk factors for COVID-19 Care 2.

•

lower-risk patients self-monitor symptoms daily and may receive lower frequency of clinical assessment, but the household is contacted frequently.

Review symptoms and perform remote examination Monitor trends over time and take account of the full clinical picture. The symptom complexity and changes in features over time may be more significant than isolated responses.

•

Assess breathing and general symptoms. See Daily Checklist.

•

Include video observations, if available.

Version One. 25 November 2021.

17

•

To minimise exposure, only perform an in-person examination if it will change clinical management or when you are not confident that remote assessment is adequate.

•

Consider important acute complications of COVID-19.

•

Ask about mood and mental wellbeing.

•

Consider whether symptoms are due to a different new diagnosis or a preexisting condition.

Triggers for moving from COVID-19 Care 1 to 2

•

•

Escalate care if the patient develops features indicating moderate severity: •

worsening pattern of general symptoms.

•

mild symptoms with one or more of: •

constant fatigue

•

worsening headaches

•

worsening cough

•

becoming short of breath with effort

•

constant aches

•

diarrhoea (frequent loose bowel motions)

•

chills, fever

•

abdominal pain

•

vomiting

•

rashes, swelling, or blistering of toes

•

Fever greater than 38°C

•

Rising heart rate from normal baseline

Arrange delivery of a pulse oximeter with instructions to the patient or caregiver on how to use. Reassess the patient when the pulse oximeter is available later in the day, if possible. An SpO2 above 93% would be consistent with moderate severity.

Version One. 25 November 2021.

18

Important acute complications of COVID-19 Besides pneumonitis, patients with COVID-19 have increased incidence of other complications: More common complications • • • •

Delirium in older patients Anorexia Orthostasis/dysautonomia Gastrointestinal upset

Less common complications • • •

Venous thromboembolism (VTE) Cardiac complications, e.g. myocarditis, acute coronary syndrome, heart failure Acute kidney injury

See BMJ Best Practice – Coronavirus Disease 2019 (COVID-19) Complications.

Investigations Do not routinely perform blood tests or chest X-ray on community patients for COVID-19 as the benefits of obtaining this information are generally not significant enough to warrant the risk of increased COVID- 19 exposure in the community.

Consider deferring any non-urgent or routine checks until the self isolation period has been completed.

If blood tests or chest X-ray are deemed essential for management, hospital admission is likely to be appropriate.

•

If unsure, seek COVID-19 advice.

If other investigations are required (e.g. relating to other illness or injury), seek COVID-19 advice about appropriate investigation and venue.

Management of co-morbid conditions Review status of co-morbidities and medication compliance. Ensure the patient has their usual medications and advise about non-contact delivery from pharmacy.

•

Encourage good hydration and consider stopping or dose reduction of medications for example, Empagliflozin, angiotensin-converting enzyme inhibitors

Version One. 25 November 2021.

19

(ACE inhibitors) or angiotensin-II receptor antagonists to prevent acute kidney injury if at risk of dehydration.

•

Plan sick day management in patients with diabetes, including those on insulin.

Consider whether the household is known to the community nursing or other community healthcare team and advise them of the patient's COVID-19 positive status.

Version One. 25 November 2021.

20

Daily Symptom Checklist (for duration of care) This is also available in an excel spreadsheet format you can download at http://portal.wboppho.org.nz/covid-19/

Version One. 25 November 2021.

21

Referring to Hospital Care Triggers for moving patient to hospital or palliative care Escalate care if the patient develops:

•

•

rapid deterioration.

•

worsening fatigue, profound exhaustion.

•

fainting, falls.

•

coughing up blood.

•

fever greater than 40°C.

•

severe shortness of breath at rest

•

Clues to respiratory compromise. Include: Talking with single words or short sentences; Pausing between sentences to catch their breath; Noisy breathing; Blue face or lips; Respiratory rate greater than 20 breaths per minute.

•

chest pain on breathing in or tightness/pressure in the chest

•

new onset of confusion or becoming drowsy

•

change in oxygen saturation (SaO2): •

Pre-COVID-19 SaO2 was greater than 94% or was unknown, then SaO2 trigger is less than 92%, or a drop of 3% or more from baseline, or a drop of 3% from resting to after exercise.

•

Pre-COVID-19 SaO2 was 94% or less, then SaO2 trigger is less than 88%, or a drop of 3% from baseline, or a drop of 3% from resting to after exercise.

•

Note that the safety of formal exertional desaturation tests such as the 1 minute sit-to-stand test have not been evaluated for COVID-19 and should not be performed routinely. Asking the patient to walk around the room may suffice.

•

unexplained heart rate greater than 100 beats per minute

•

dehydration – reduced oral intake and minimal urinary output in 12 hours.

•

cold, clammy, mottled, or pale skin.

•

other factors indicating need for management in hospital

If unsure about management, seek COVID-19 advice.

If escalation to hospital care is required call on call medical SMO via switchboard WBOP 07 579 8044 and submit ereferral as per usual referral but mark as Covid Positive.

Inform the patient that they are to wear a mask when arriving at the hospital.

Version One. 25 November 2021.

22

Transport to hospital If ambulance transfer is required then refer though the normal process. It is vital that the dispatch team is aware that the patient is covid positive Alternate transport – if the patient is clinically stable and able to be transported by a household member then this can occur, only if it is clinically safe to do so

End of Life Care TBC More details to come

Access to syringe driver TBC More details to come

Access to Oxygen TBC More details to come

Funding Information on the claims process has yet to be released. Please log all activity so you can claim for it when the funding model is issued.

Version One. 25 November 2021.

23

Further Information •

Ministry of Health – Interim Guidance – Clinical Management of COVID-19 in Hospitalised Adults

•

Dee Mangin, Hamilton Family Medicine, Canada: •

Assessment, Monitoring and Management of COVID

•

COVID-19 Management of Mild to Moderate COVID in the Community: Learnings from Canada [video 55 minutes 58 seconds, hosted by Canterbury Primary Response Group (CPRG)]

•

COVID-19 Management of Mild to Moderate COVID in the Community: Learnings from Canada [slides]

•

General Practice Monitoring and Management of Mild to Moderate COVID19 Illness – Learnings from Canada [summary of unanswered/text Q&A from webinar]

•

Centre for Evidence-Based Medicine (CEBM) – Are There any Evidence-based Ways of Assessing Dyspnoea by Telephone or Video?

•

NZ Telehealth Forum & Resource Centre – Providers

•

World Health Organization – Home Care for Patients with COVID-19 Presenting with Mild Symptoms and Management of Their Contacts

•

BMJ – Remote Management of Covid-19 Using Home Pulse Oximetry and Virtual Ward Support

Version One. 25 November 2021.

24

Appendix 1: Guide to Models of Care Level 1 / Low:

Level 2 / Medium:

Asymptomatic or mild symptoms

Moderate symptoms / At risk of complications

Key Components

Key Components •

Self-monitor symptoms

• •

Telehealth health check monitoring every other day Referral for other health and social supports Providers General practice, telehealth services, Māori and Pasifika clinical providers, community pharmacy

Providers •

Workforce (may include) Clinical workforce for monitoring and management: Nurses, nurse practitioners, GPs, telehealth services clinical team, clinical support through Māori and Pasifika providers, community pharmacists, physiotherapists, counsellors

Self-monitor with twice daily pulse oximetry readings communicated to primary care team Daily Telehealth health check monitoring and consultation Supported by multi disciplinary clinical team with shared care approach. (In person care may be required for noncovid urgent care needs).

•

Whānau at the center of a general practice virtual multidisciplinary team providing shared care approach for daily virtual/telehealth monitoring and supportive management of COVID, co-morbidities and chronic care.

Virtual team ‘hub model’ for the coordination of health services to be regionally determined across primary, community and secondary care

Workforce (may include): •

Non-clinical workforce for support: HIPS & Health Coaches, Māori and Pacific providers, translation services, community support workers, kaiāwhina, cultural support workers, service navigators •

Decision-making framework Triage and escalation pathway, testing and results for consults

Clinical workforce for monitoring and managing care: GPs and Urgent Care doctors, nurse practitioners, nurses, clinical support through Māori and Pasifika providers, community pharmacists, secondary care clinicians and nursing, telehealth services clinical team, paramedics, physiotherapists, counsellors Non-clinical workforce for support: HIPS & Health Coaches, Māori and Pasifika providers, translation services, community support workers, kaiāwhina support, cultural support workers, service navigators

Training / Guidance

Decision-making framework:

COVID-19 Community HealthPathways, clinical webinars, 0800 COVID-19 Positive Line for cases, Clinician to Clinician helpline

Triage and escalation pathway, testing and results for contacts

IT

COVID-19 Positive Line for cases, Clinician to Clinician helpline

Integration with shared care record between NCTS, public health, primary care (PMS), telehealth and secondary care providers

IT:

Equipment

Equipment:

Patient access to cell phone with data or landline (video capability if available), testing kits, PPE

Pulse Oximeters, thermometers, cell phone with data or landline (video capability if available), testing kits, PPE, 02 (in exceptional circumstances

Escalation

Escalation:

Via telehealth or 111 if symptoms deteriorate Version One. 25 November 2021.

Via telehealth or 111 if symptoms deteriorate

Training / Guidance: COVID-19 Community HealthPathways, clinical webinars, 0800

Integration with shared care record between NCTS, public health, primary care (PMS), telehealth and secondary care providers

25