COVID-19 Pathway May 5, 2020 Healthy People, Healthy Saskatchewan The Saskatchewan Health Authority works in the spirit of truth and reconciliation, acknowledging Saskatchewan as the traditional territory of First Nations and Métis People.
COVID-19 Pathway Introduction • In preparation for the anticipated demand on healthcare services for COVID-19, physicians and administrative leaders within the SHA have created a COVID-19 Pathway that outlines a framework for how patients (COVID-19 and non-COVID-19) best access and flow through the healthcare system at a local and provincial level. • The COVID-19 Pathway framework includes the flow of patients through acute care, community services and focus points for vulnerable populations.
COVID-19 Pathway Scope • The COVID-19 Pathway is a provincial roadmap that outlines the care journey for patients (COVID-19 and non- COVID-19) from the time they seek medical advice (e.g., 811, 911, family physician, emergency department) through the community or acute care and back home. • The pathway: • Outlines the optimal flow for patients • Identifies provider and system roles • Builds supports required at each step of the patient’s journey.
COVID-19 Pathway Goal The goal of the pathway is to: • Ensure patient and provider safety during the pandemic. • Improve teamwork and interdisciplinary collaboration. • Improve practitioner awareness and understanding of their role and the interdependency of their role, as well as system supports available and how these supports contribute to the patient journey. • Improve the alignment, coordination and efficiency in our response to COVID-19.
COVID-19 Pathway Key Supporting Initiatives Links to strategies and processes for population health, primary Resource care and palliative care to ensure coordinated entry and exit Coordination from acute care. Standardization of clinical documents such as order sets, work Clinical Standards standards, algorithms and other tools to support consistent Support practice throughout the SHA. Resources for clinical training and practice for advanced airway Clinical Training management will be available shortly. Skill lists to identify and Practice individual competency gaps and teams with the necessary capabilities are available on the COVID-19 website. An inventory Resources of learning resources to support training is in development. Link academic and clinical expertise to establish a repository Evidence Support and to synthesize new and emerging evidence based on the Think Tank COVID-19 pandemic.
COVID-19 Pathway How It Relates to Connected Care Connected Care for the People of Saskatchewan is the SHA’s service delivery model. Throughout COVID-19 pandemic planning, the SHA continues to mobilize in a way to ensure we meet the objectives of our pandemic planning strategy: detect, contain and mitigate while maintaining the foundation of our healthcare system: Connected Care.
COVID-19 Pathway How to Use the Pathway Use the COVID-19 Pathway to: • Create service connections for patients by providing a visual representation of seamless service alignment through consistent processes and coordinated use of resources. • Provide the framework for provincial standardization of related processes, tools, order sets and required training to mitigate risk from variation. Consistency supports patient and staff safety, improved outcomes and patient satisfaction. • Improve practitioner awareness and understanding of their role and the interdependency of their role, as well as system supports available and how these supports contribute to the patient journey.
COVID-19 Pathway Your Role As a leader, your role is to: • Continue to identify and communicate gaps where processes are not clear. • Collaborate in the development and promote the usage of standardized clinical documents to help manage and improve the process. • Incorporate new best practices based on sound evidence during the COVID-19 pandemic.
Acute Care Pathway
Acute Care Pathway Purpose • To streamline the entry and exit points of all patients flowing through acute care. • To serve patients suspected of or diagnosed with COVID-19 requiring in-patient medical care due to trauma and/or medical conditions unrelated to COVID-19, non-threatening COVID-related symptoms or COVID-related acute respiratory distress. • To identify designated COVID intubation sites that will provide airway management for patients diagnosed or suspected of COVID-19. The highest level of safety for medical staff and patients is achieved by ensuring that an airway team is present, skilled and trained for these events.
Acute Care Pathway Goals • Mobilize specialized expertise to support providers throughout the province. • Ensure that COVID-19 patients with medical needs receive timely, standardized best practice care that is informed by current evidence. • Coordinate and standardize the transportation of patients. • Utilize hospital capacity in a coordinated way to meet current and future demand.
Acute Care Pathway Key Supporting Initiatives Coordinated Patient Includes role descriptions of COVID-19 ready facilities and EMS Bypass Flow Plans Protocols. System Flow Provides centralized support to inform decision-making in primary care Coordination Centre and small hospitals, as well as administrative support for decisions (SFCC) about patient disposition and transport destinations. Critical Care, Medicine and Emergency order sets have been developed. COVID-19 Order Sets Other COVID-19 related order sets have been created or are in development for Maternal Children’s, Palliative and Long -Term Care. Standards will be supported by training for advanced airway Clinical Standards management and COVID Physician Access Line personnel. Designated Intubation Identify and support through training and simulation designated sites Hubs that will serve as intubation hubs throughout the province.
Acute Care Pathway System Flow Coordination Centre (SFCC) What is it? A single, system-wide Physician Access Line and provincial bed flow coordination service. All patient admissions and transfers (COVID-19 and non-COVID-19) will be coordinated through the SFCC. It will enable us to see all patients and bed capacity, and work together as a province to meet and care for patients in the right place, at the right time, as close to home as possible.
Acute Care Pathway Visual INCLUDE VISUAL OF PATHWAY Located at www.saskatchewan.ca/COVID19 in Information for Health Care Providers > Clinical Practice Resources > COVID-19 Pathway
Community Care Pathway
Community Care Pathway Purpose • To follow the patient experience (both COVID-19 and non-COVID-19) through the primary healthcare system. • To follow patients seen at Assessment and Treatment Sites for both COVID and non-COVID-related health concerns. • To follow patients transitioning from the community into acute care and from acute care into the community, including post-acute supports and services. • To serve as a communications tool to help providers understand how and where to assess COVID-19 and non-COVID-19 patients.
Community Care Pathway Goal To connect the following system access points to support the patient journey: • Screening, Public Health, Testing Sites, Assessment and Treatment Sites • Primary Care Clinics • Family Physician Offices • Virtual Care • Vulnerable Populations • Intermediate Care • Continuing Care
Community Care Pathway Visual INCLUDE VISUAL OF PATHWAY Located at www.saskatchewan.ca/COVID19 in Information for Health Care Providers > Clinical Practice Resources > COVID-19 Pathway
Vulnerable Populations Supports and Services • Working in partnership with other organizations and communities, individuals without financial and social means will be supported to safely and effectively self-isolate as directed by the provincial public health order. • A standard approach to assisted self-isolation sites (ASIS) will be developed provincially and implemented locally based on local resources and preferences (e.g., hotels, schools, churches). We will also develop an integrated system for active case finding, monitoring, sentinel surveillance and public health reporting.
Virtual Care
Virtual Care How Virtual Care Will Support the Pathways • Provider to patient videoconferencing (PexIP) • Decreasing exposure while providing care • Assessment and Treatment Sites, Inpatient Virtual Care, Long-Term Care • Decreasing visits to emergency rooms and minor emergency clinics • 811 – Second level physician triage • Online medical control for “Treat and Release” • Ongoing remote assessments • Virtual Care Medicine Clinic • Virtual Critical Care Clinic • In-home and hotel-based community care • Home health monitoring • Improving and ensuring information flow as a foundation for Virtual Care
COVID-19 Pathway Next Steps We will continue to advance this work by: • Identifying intermediate care requirements and resources to address needs. • Engaging in post-acute care planning for continuing care residents who may require acute care services. • Establishing deeper connection points for contact tracing and monitoring to prevent the spread of the virus. • Incorporating linkages with pathology for management of the deceased if demand exceeds capacity. • Linking it to the Connected Care strategy.
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