NSHA is committed to keeping all physicians up to date with information from the provincial incident management team and all clinical information required to assist in our provincial response.
Primary Health Care Updates
Earlier this evening the Department of Family Practice issued an update of interest to Primary Health Care clinicians that may be of interest to the larger group. The update contains:
- An updated link to the Quick Reference Guide for Screening Patients for Coronavirus Assessment Centres
- Information on Patient Triage
- Professional Standards on PPE for Physician offices
- Information on the work for virtual care and current fee codes available for telephone support
Our Process for Fielding Your Questions
We have channeled a large number of questions through the Medical Affairs team and an answers are known, we will now keep a running list under this mail out. If you don’t see your answer there, please know we are working on obtaining the information and it is likely that it involves work that is underway by a working group but not close enough for definitive answer. We will continue to provide updates on all items raised in this way.
All Physician Webinar
This evening we hosted a webinar with members of the provincial Incident Response Team. More than 200 physicians joined us online as well as partners at Doctors Nova Scotia who also provided the technology. We apologize for early technical issues that prevented us from starting on time as this was the first time Doctors NS used the technology with panel experts joining remotely. There were so many good questions. When the hour ended, more than 48 questions remained in the queue and we have committed to answering each one using this newsletter as soon as we receive them. Thanks to our panel members (Dr. Cheryl Pugh (moderator), Bethany McCormick, Dr. Todd Hatchette, Dr. Gaynor Watson-Creed, Dr. Ian Davis, and Dr. Doctors Nova Scotia for facilitating this way for us to connect.
DNS is hosting two additional webinars for physicians, one tomorrow evening from 6:30pm-8:00 pm (register
here
.)
and one on Monday March 23 at the same time (register
here
).
Printable resource tool:
self-monitoring, self-isolation, and isolation for covid-19
Interim Site Leadership – Cape Breton Regional Hospital
I am very pleased to announce interim site leadership for Cape Breton Regional Hospital. As you know, we have been working to fill this vacancy as a key part of our ongoing support to the site medical staff, and even more crucial as we move into COVID-19 response planning and support. Dr. Chris Lata (Infectious Disease), Dr. Meghan Keating (Family Medicine), and Dr. Blair Williams (ENT) will work as a combined team to provide full-time leadership to the site. I would like to thank this innovative group of doctors for stepping up in a time of great need.
Interim Site Leadership – South Shore Regional Hospital
I am pleased to announce that Dr. Heather Johnson has stepped into an Interim position of Site Lead for South Shore Regional Hospital on a month to month basis to ensure physician representation on key issues related to COVID-19. Thanks to Dr. Johnson, a long-respected medical leader in the zone and in our province.
Provincial and Federal Situation Update
- 934 negative tests; 7 positive cases: 6 presumptive; 1 confirmed for Nova Scotia
- News conference with Premier, Dr. Strang, Dr. Carr (NSHA CEO) and Dr. Jangaard (IWK CEO). Focus on new cases, health system changes, limiting gatherings to fewer than 50, closure of bars and restaurants to dine-in service as of Thursday. View Release
- IWK/NSHA issued news releases to advice of health system changes to allow for resources to be redeployed. View Release
- The province is beginning to run radio ads on all stations, print ads in dailies and weeklies, all social media platforms, Access Centre Screens
High level overview of Government of Canada announcement today
All must take all action through social distancing to protect one another; As much as possible, stay home. Parks Canada suspending visitor services at all national parks and historic sites as of Wednesday.Global Affairs new emergency loan program of up to $5000 for Canadians to come back home or cover needs if they have to wait to get back; making another major announcement tomorrow on economic actions to support Canadians. By end of week, changes announced re. tax season.Government is looking into Emergency Measures Act.
Virtual Care and Compensation Update
An update from Doctors Nova Scotia
Doctors Nova Scotia is working closely with government on a solution to enable physicians to provide patient care using the telephone. We are finalizing the details and expect to make an announcement in the next few days. We know that many of you are already providing care virtually in response to the province’s social distancing protocol. We encourage you to keep track of any virtual visits that you’re doing this week until we have more details for you.
We are also working with government to enable other virtual care tools to support physicians in providing telemedicine services and asynchronous communication with patients. We expect this announcement to follow closely.
Many physicians are worried about what to do if they are unable to work in their normal capacity during the pandemic. W
ith health services being cancelled, physicians are concerned about income loss, loss of
clinical work, supporting their employees and maintaining business as usual. We want you to know that DNS is having those conversations with government as well. An update on this will follow.
Elective Surgery Cancellations – Perioperative Services
To support efforts to contain the spread of COVID-19 and the conservation and redeployment of resources, Nova Scotia Health Authority is temporarily suspending a number of services. This includes the cancellation of non-urgent/elective procedures, clinics, surgeries and appointments.
Effective March 18, 2020, all elective surgeries are being cancelled until further notice. Time-sensitive cancer surgeries and other urgent surgeries will continue to be provided. Emergency cases will continue with only level 1 and level 2 cases completed after hours. These measures will help limit non-essential pre-operative and post-operative interactions for patients and clinicians within our day surgery units, operating rooms, post-anesthesia care units, and surgical units. They will also allow us to preserve vital human and equipment resources, and create capacity to establish COVID-19 units in designated hospitals.
Examples of non-urgent/elective cases include, but not exclusive to:
- Arthroplasty, Arthroscopy, extremity surgery
- Elective Cholecystectomy, non-incarcerated hernia surgery, non-urgent upper and lower endoscopy, hemorrhoidectomy, nissen fundoplication
- Tonsillectomy, tubes, septoplasty, sinus surgery, sleep apnea surgery, benign head and neck, undetermined or low suspicion head and neck lesion, non-urgent laryngoscopy
- Hydrocele, circumcision, TURPs
- Varicose veins, non-limb threatening claudication, non-life threatening aneurysms
- Ovarian cystectomy, tubal ligation, uterine ablation, hysterectomy
Endoscopy Guideline
In response to the global pandemic declaration by the World Health Organization, all non-urgent endoscopies will be suspended provincially.
This document will serve as a guideline for what the Provincial Endoscopy Network would consider urgent and appropriate for endoscopy with proper precautions. This is to be followed until further notice. The guidelines are subject to change at any point and will be reevaluated on a daily basis. We will provide regular updates.
- All patients booked for non-urgent procedures should be cancelled immediately. This includes FIT+ patients.
- If there is uncertainty regarding case appropriateness direct the question to Paul Johnson, Dana Farina or Heather Francis, and we will evaluate together in co-operation with the local team.
- Patients with high suspicion of cancer (ie abnormal imaging, palpable rectal mass) are to be cancelled. We know that such patients cannot wait weeks or months. Our definition of urgent/ non-urgent will evolve depending on what is happening with the Covid-19 pandemic. For now tell such patients that they are cancelled but will be identified as a priority case.
- We are asking that physicians identify the priority cases (high suspicion of cancer) going forward. This will allow us to determine the resource needs and coordinate booking the urgent cases as soon as possible.
- We will not be able to provide cancelled patients with definitive timelines for rebooking. This is a very fluid situation with much uncertainty. We will re-evaluate access for high priority cases at least on a weekly bases. We will provide additional information regarding the process for these patients in a follow-up communication.
Follow up Testing Protocol of COVID-19 Cases
A new quick reference document is available
here
Business Continuity Plan for Laboratory Services
The following measures will be put in place effective immediately:
- NSHA is requesting physicians and nurse practitioners to restrict orders for all non-urgent laboratory testing including routine* monitoring of patients, regular check-ups, HGB A1C and routine urinalysis. Any laboratory testing that does not have a direct impact on immediate patient management should be differed. Time-sensitive testing such as pre-natal care should continue. (*At Healthcare provider’s discretion. Routine CBCs, thyroid panels, B12, are examples of “routine”. Required management of chronic illness (ie. renal, cancer, INRs) will not be impacted.)
- Swabs to support COVID 19 testing must be conserved and will be strictly managed.
Due to a global shortage of testing swabs, the QEII Virology Laboratory has implemented the following changes:
- Testing of critical specimens such as eye/vitreous and CSF will continue as normal.
- HCV and VZV from genital and skin specimens is suspended.
- Stool samples for viral pathogens is suspended (norovirus, adenovirus and rotavirus).
- The turnaround time for other routine microbiology tests in CZ may be delayed. As the situation evolves, further restrictions in laboratory testing may become necessary.
Infection Prevention and Control Working Group Direction of Patient Transfers
Prior to any patient being accepted as a direct transfer from another hospital in Canada or from another country Infection Prevention and Control should be contacted and will advise on appropriate precautions.
All patients admitted from the community, should be screened for possible COVID-19 : Ask the following questions:
- Does the patient have new cough or exacerbation of chronic cough OR fever >38; has the patient travelled outside of Canada in the last 14d or has the patient been in contact with a known or suspected case (symptomatic person) within the past 14d (includes a symptomatic person who has travelled outside Canada within 14 days)
- Patients who meet the travel or contact criteria but who do not have fever or cough, should be managed with routine droplet/contact precautions for 14d and do not need admission to a COVID site or inpatient COVID ward.
- Should the patient develop cough and/or fever during the 14d from return/exposure they should be tested for COVID-19 and if positive, transferred to a COVID ward.
- Patients who meet all of the COVID screening criteria (travel/exposure plus fever and/or cough) should be taken to a COVID site and admitted to the COVID ward and tested for COVID-19. If negative, the patient may be transferred out of the COVID ward.
- If positive, the patient should remain in the COVID ward.
Further direction on interprovincial transfers are coming soon.
Self-Isolation after COVID-19 Testing
Self-isolation is a highly effective strategy for disease containment. Currently, Public Health is requiring all Nova Scotians that have been tested for COVID-19 to self-isolate for 14 days after possible exposure.
Although the risk is relatively small, it is still possible to develop the infection during the 14 day window after exposure. This includes people who have tested negative for COVID-19. Completing the self-isolation period will help reduce risk of spreading COVID-19.
You are required to self-isolate for the full 14 days even after you receive your test result
.
We would also encourage you to contact your local Public Health office to speak with a health care professional should you have any concerns or questions.
Public Health delivers test results to people who are tested for COVID-19. Results are typically delivered within 48-72 hours of testing, although this may vary based on testing process and volumes.
Long Term Care and Home First Funding
NSHA Continuing Care is working with DHW for approval to use Home First funding beginning immediately as part of our COVID-19 response.
The requirement to provide a quick response to unique client situations and to assist with bed flow pressures will require NSHA to be flexible and nimble in regards to Home First and IADL programming. We are seeking support from DHW to be able to respond as needed.
NSHA Cafeteria Dining Locations and Social Distancing
Current communication of social distancing have resulted in significantly reduced cafeteria customers and seating areas appear less occupied by employees who for the most part, are naturally distancing themselves from one another. Signage asking individuals to practice social distancing are posted in NSHA cafeterias. In addition to social distancing, Nutrition and Food Service cafeteria employees are prioritizing thorough and frequent sanitization of high-touch areas including cafeteria tables, not accepting reusable dishes including travel mugs, promoting electronic payment as the preferred method of payment (not a requirement as some rural sites do not have debit/ credit machines- although we are planning to implement asap).
NSHA employees and physicians require a place to break and refuel. The cafeteria seating areas will remain open and tables and chairs will be moved to two meter spacing. All fixed seating will be blocked off if it doesn’t support adequate social distancing.
New Video to Demonstrate Appropriate Application and Removal of PPE
Please view the video
here
.
*Updated*
Physician Referrals to Coronavirus Assessment Centres
Our incident management team has created Pre-Screening Guidelines for patients presenting in your offices. This provides a clear direction to physicians on referral to Coronavirus Assessment Centres using the fax form linked below. The fax form was updated today.
Today, Family Practice issued a specific screening guide for Family Practitioners and it is available with the resources below.
Please note that in the effort to get these crucial pieces of documentation and information out to you as quickly as possible, there is a likelihood of regular ongoing updates and new versions- for the most recent version, please check the
website
. We are carefully dating communications to keep you up to date.
Fit Testing for Physicians
Only physicians who are providing aerosol generating procedures (positive pressure ventilation (BiPAP and CPAP), endotracheal intubation, airway suction, high frequency oscillatory ventilation, tracheostomy, chest physiotherapy, nebulizer treatment, sputum induction, and bronchoscopy) should be participating in fit testing at this time. Staff members are working to reach all physicians in each zone to determine their fit testing status.
For information about fit testing in your area, contact your zone Occupational Health and Safety Lead:
Upcoming Fit Testing Clinics for Physicians in the Northern Zone
Fit testing takes approximately 15 minutes.
You must be clean shaven or you will not be fit tested.
Beginning the morning of Tuesday, March 17
th
at 0700 hours, call to make your appointment at 752-7600 ext. 2935 (Aberdeen Regional Hospital).
If you have to leave a message, please indicate the site and the block in which you would like to have your appointment (ex. “CRHCC – morning anytime” or “ARH evening after 1900”).
You will be called back with the appointment closest to your preferred time. No need to call back and confirm unless you cannot make this appointment time.
Aberdeen Regional Hospital – Safety Office B213b (Basement)
Wednesday March 18, 0700-0900
Tuesday March 17, 1700-2100
Colchester East Hants Health Centre – Occupational Health Room A 2009 (2
nd
floor past dialysis)
Thursday March 19, 0700-0830
Wednesday March 18, 1700-2100
Cumberland Regional Health Centre, Room 1675
Wednesday March 18, 0700-0900
Thursday March 19, 1700-2100
Note:
If you have already booked an online appointment for CEHHC this Thurs/Friday, and you would prefer one of the above times, please call to make an appointment. Contact Alison Dougan (
alison.dougan@nshealth.ca
)
