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COVID Guidelines 

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This page is designed to help understand the current guidelines for the assessment and management of COVID suspicious or confirmed patients. 

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Public Health Comprehensive Guide on Case Testing, Management, tracing (39 pages)- April 15

 

When to Test for COVID

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May 25th:  Significant Practice Change:

 

Testing Criteria:

• Symptomatic

• Asymptomatic but concerned about exposure to known or potential cases

• Asymptomatic and have risk from exposure in line of duty (essential workers, health care workers, etc.)

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A few caveats recommended by ID:

• If someone is tested, generally, they need to self-isolate until results are available.

 

• Several questions have come of this recommendation, particularly for asymptomatic patients seeking testing, which are further clarified here by ID:  

  • "The self-isolation post-testing for asymptomatic individuals is a discussion between the assessor and the patient. It’s about balancing an individual’s autonomy and public health.

  • 1)      If the patient is being tested due to a known exposure to a person with COVID or have been sent in by TPH as part of an outbreak investigation then they should self-isolate for 14 days from date of last exposure regardless of test result

  • 2)      If the person is an essential worker who does not meet the criteria above and is asymptomatic they can work and should follow public health messaging regarding social distancing and limiting exposures to others

  • 3)      If a person is not an essential worker and does not meet criteria 1 then they should self-isolate if feasible while awaiting test results. If self-isolation is not feasible then they should follow public health messaging regarding social distancing and limiting exposures to others."

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• Patients are counselled that the test is simply a ‘snapshot’ in time and a negative test today does not mean you won’t get COVID tomorrow or screen positive for COVID tomorrow.

• If an individual is exposed, the best time to get the test is at least 7 days after exposure.

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MGH Main When to test Infographic 

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MOH Patient Screening Guidance/3 pages  (may 17th)

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MOH COVID Symptom review (Sept. 27)

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Full provincial guidance document on updated testing/11 pages (May 14th)

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COVID Assessment Clinic Information

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Will describe the Process and flow and documents relating to the Covid Assessment clinic

How the Assessment Clinic Triages phone calls for Patient Appointments (algorithm)

Clear Flow chart of all roles and process at Assessment Centre

Copy of Clinic Paper Full assessment form (triage and MD)

How to Document Assessment Clinic Visit on Powerchart (expected method)

Copy of ED MD Paper Covid Assessment Form (more for purple zone)

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Which patients will not be seen at the Clinic (e.g. sent to ER to register)

COVID Assessment Clinic Exclusion Criteria (Aug 24- revalidated Oct 9)

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Ontario Health Old update on COVID Assessment center function(purpose, testing, assessment)

Update on Scope and function of Toronto COVID Assessment Centres(May 29)

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COVID Center Counselling FAQ worksheet (swab efficacy, transmission, symptomatic or asymptomatic contact, role of CAC and popups) Oct 12th:

MGH CAC Counselling FAQ worksheet (Oct 12)

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Sending from COVID Assessment Clinic to Purple Zone

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Approach to labs/DI when sending the patient from Assessment to Purple zone

COVID Assessment Clinic to Purple Zone

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MGH COVID Discharge Criteria/followup process

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MGH is developing a "Post Medicine Consult" (purple zoneish) discharge criteria and followup flow map to ensure safe outpt. managment of COVID patients after admission or Medicine consult in ER and discharged. We may be part of this process if dishchaged by us. These are complex flow maps!

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Discharged COVID patient GIM pathway (e.g. ready for discharge)

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After Discharge COVID patient Virtual Follow-up  Algorithm

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ED COVID Discharge Telephone Follow-up / POD

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May 12:  Please Copy the ED callback forms you have completed and then code and drop off in Leith's box.

April 26: We are starting a new process of calling all identified (by MD) non-swabbed COVID patients 2 days post discharge.  Full details to follow. 

• MD will identify patient at time of discharge and put patient sticker on "ED COVID Telephone Follow-up Form" found in pink folder in each area, and leave form in grey folder.  Patient Also then Gets Special Discharge Handout (ED COVID POD). 

• Second MD 2 days later (Recall MD to start) will use form to complete structured follow-up call with patient.  Completed forms will be managed like recall forms.  

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Review of Process for ED COVID Telephone Followup

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Copy of ED COVID Teelphone Follow-up Form for MD to use

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Copy of ED Patient Oriented Discharge (POD) Handout  for COVID patients

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Physician Scripted Voicemail message for unanswered follow-up calls

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COVID Results Viewing

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Staff tested through Occupational health cannot see results with Mychart or Self-viewing portal below. Staff or Patients assessed in COVID Clinic or ER can use process below (Need Name, DOB and MRN).

Patient COVID result self viewing process

Link to MGH Result Self-Viewing Portal ( https://covid19.tehn.ca/resultupdate/ )

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COVID Clearing/Return to work

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MGH Quick Summary of HCW and Non-HCW return to work

MOH quick (3 page) guide on Clearing COVID patients for return to work (second page)

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MGH COVID19 Return to Work Permission Letter (non-testing approach)

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COVID Ongoing Ramp Up/Down Plan

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As we move past the initial stage,  the hospital has plans for ramping back up to near pre COVID levels for Surgical, DI and Cath labs services.  Also consideration for how to ramp back down as need migh arise.

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MGH One page overview of Ramping up Plan June 1 - Sept 4th and as needed Ramp down Plan for Surgical, DI, and Cath lab

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Visitor Policy

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There is a significant restriction of visitors due to COVID. This applies to both General patients and COVID patients. 

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Oct 9th: updated Visitor Policy: Summary: 1 patient visitor if they are "essential" to the visit (full list in policy)

MGH ED Visitor Policy - Oct 9th

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Death/Post-Mortem issues

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SCOVID specific issues and management (e.g visitation, transport, trillium). Currently covered in the Critical Care pathway.

Go To Death Section of Critical Care Pathway

 

Need to Isolate (Public Health Class Order)

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On April 1st;  Public Health issued the Class order to all persons residing in  Toronto who are:  Diagnosed with COVID, have Symptoms of COVID, are awaiting results of COVID testing, have reason to believe they have COVID, or close contacts of the preceding people,  need to isolate and stay in isolation for 14 days from first symptoms.

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If patients or caregivers (parents, custodians, officers) are unsure or reluctant to do the above, you should fill out and give them a copy of the Class order as it pertains to them. You can also give them the Class order fact sheet.

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Letter to fill out for Patient Notifying them of COVID19 Class Order/Need to Isolate

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Public Health COVID19 Class Order Fact Sheet for Patients

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Copy of Original Public Health COVID19 Class Order (April 1)

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Reporting of Non-Compliant COVID Patients

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We have been advised by the Associate Medical Officer of Health that Public Health should be notified via public health hotline 416-338-7600 (8am-8pm) or 311 after hours for any PUIs or COVID+ patients that are believed to potentially be non-compliant with self-isolation direction to support any contact tracing and enforcement where possible. 

Similar to our processes for PH notification currently in place, please have the clerk call PH hotline or 311 to connect you with PH if appropriate. We will need some time to digest the contents of this communication as a group.  

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Essential Workers/Services Summary

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Taken from the Ontario list of essential workplaces:

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• Supply Chain: distribution of goods

• Food:  Food Stores (convenience store), Restaurants, LCBO

• Services: Gas station, Laundry, Car repair, Courier, Vet, Hotels, probably plumbers, electricians

• Financial Services: Banks, Insurance, Real Estate

• Telecommunications & IT: phone, computer, Newpaper

• Maintenance: Superintendent

• Transportation: Bus drivers, taxi drivers, transport trucks, vehicle depots,

• Manufacturing: steel, medical supplies, other essential goods

• Food production: farmers, food production plants

• Construction:  if still working and for essential services (e.g. public buildings)

• Energy: electrical supply companies

• Community services: Sewage, garbage, water, public works repair, legal system, government services

• Health care & social services:

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