Tonight's update include articles from last night that were updated due to document improvement or repair of broken/missing links. We apologize for any confusion. Please delete yesterday's memo from your email system and refer to the
archived version on the physician
site for reference.
*Updated* Guidance for disposition of adult patients presenting with confirmed or suspected COVID-19
If a patient is identified through 811, 911, or presents in any Emergency Department in Nova Scotia and meets the COVID screening case definition (new or worsening cough plus travel outside Canada within 14 days OR contact with a presumptive or confirmed COVID-19 patient OR contact with a symptomatic person who has travelled outside Canada in the last 14 days) and has other “red flags”, the patient should be placed on contact/droplet precautions and arrangements made for the patient to be transferred to the nearest COVID hospital. In order for the transfer to be arranged, the COVID physician in the closest COVID unit should be contacted through locating to accept the patient in transfer. Patients should NOT be transferred until accepted by the receiving COVID physician. The patient may be observed in the Secondary In-hospital assessment area or admitted directly to the COVID unit or ICU as applicable.
Patients who do not meet the COVID screening criteria should be managed on contact/droplet precautions at the hospital they present in and tested for COVID (irrespective of travel history). If the COVID test is positive, the COVID physician at the nearest COVID hospital should be contacted to arrange transfer the COVID unit. If there are concerns about potential for COVID among patients who do not meet the COVID screening definition, the on-call COVID physician at the closest COVID hospital can be contacted to discuss appropriate disposition.
COVID secondary assessment and inpatient units are currently located in the following hospitals. This document will be updated as new COVID secondary in hospital assessment centres and inpatient units are opened.
- Central Zone- QEII (Halifax Infirmary)
- Eastern Zone - Cape Breton Regional Hospital, St. Martha’s Hospital
- Northern Zone - Colchester Regional Hospital
- Western Zone – Yarmouth Regional Hospital
For guidance and information on patient clinical pathways for COVID-19 in a secondary in-hospital assessment centre, click
here.
*revised* Designated Zone COVID-19 Inpatient Units
NSHA is working to create provincial capacity for in-hospital care for COVID-19 patients who may require it. Our planning and response includes: Primary Assessment Centres for people referred by 811; Secondary Assessment Centres in regional hospitals for patients requiring some care & treatment, and; COVID inpatient units for patients requiring admission.
The following hospitals have been designated, and are prepared to host COVID-19 inpatients:
• Halifax Infirmary
• Dartmouth General Hospital
• Yarmouth Regional Hospital
• Cape Breton Regional Hospital
• St. Martha’s Regional Hospital
• Colchester East Hants Health Centre
Units have been identified based on criteria such as access to negative pressure rooms, proximity to an Intensive Care Unit (ICU), etc. Other COVID-19 units may be identified as the situation evolves.
Work will continue to make sure units are ready, and staff are appropriately trained and prepared to run the unit and safely care for patients. This will require ongoing support from many departments and program areas. As need arises and teams have plans in place, more units may be added.
Admitting to COVID Unit - Process Example
A process has been created for admitting to the HI and Dartmouth General COVID units that may be adaptable to other sites around the province. View it
here.
*New* COVID Patient Transfer Order
HAMAC has approved a new order for use when transferring between Covid-19 inpatient floor and other inpatient care areas within the facility. The form will be posted to the
site tomorrow but you can preview the information
here.
*Updated Link* NSHA Perioperative and Interventional Radiology Services during COVID-19 Pandemic -
Recommendations for Triage of Urgent, Benign and Cancer Surgery
This is a follow up communication concerning triage of surgical and interventional radiology services during the COVID-19 global pandemic. As previously communicated, all non-urgent operative and IR procedures have been suspended in all NSHA facilities effective March 18, 2020. This communication concerns approaches to defining more clearly elective from urgent cases to assist in triage of surgical and IR resources in a given hospital. For more information, click
here.
PPE Requirements for COVID-19 Patients
Here is a
presentation on the PPE requirements for patients with COVID-19.
Here is a
video on donning and doffing droplet precaution PPE
Provincial Update
As of today, March 21, Nova Scotia has nine confirmed cases and 12 presumptive cases of COVID-19, for a total of 21.
Six new cases were identified Friday, March 20. All are travel-related. The original hospitalized case has been released and is recovering at home. One of the other confirmed cases is hospitalized.
The cases are located across the province. The 21 individuals affected range in age from late-teens to mid-70's. Public health has been in contact with these individuals and are working to identify others who may have come in close contact with them. Those individuals are also being directed to self-isolate at home, away from the public, for 14 days.
The province is testing daily, working with partners at the National Microbiology Laboratory in Winnipeg. To date, Nova Scotia has 1,826 negative test results, 12 presumptive positive cases and nine confirmed cases.
As of today, dentists can no longer practice dentistry in their offices unless they deem it necessary to perform an emergency dental procedure in the best interest of the patient's health. This is an order under the Health Protection Act.
In addition to prevention measures put in place by government and the chief medical officer of health, the Nova Scotia Health Authority and the IWK Health Centre have taken steps to ensure the health system is ready to respond to COVID-19, including:
-- making changes to non-essential services so staff are available to focus on COVID-19 and essential services, such as cancer care
-- providing options for virtual care and telehealth care so doctors and other health-care providers can reduce face-to-face visits but also help patients regardless of where they are
-- restricting visitors to protect the vulnerable patients in our hospitals
-- providing support to public health as they give advice on measures to slow down the spread of the virus
-- ensuring facilities are well-prepared to meet the health-care needs of Nova Scotians during a pandemic
-- opening new assessment centres to meet the need for assessments (there are now 14 centres around the province)
