COVID-19 Remodeled & Restructured processes for entry to and - - PowerPoint PPT Presentation

COVID-19

Remodeled & Restructured processes for entry to and pathways through care for children in a hospital setting in Pakistan

• Prof. Dr. Junaid Rashid

Head & Professor of Pediatric Medicine The Children’s Hospital & the Institute Child Health Lahore, Pakistan

Routine (ETAT) Pediatric Emergency Patient Inflow in Children’s Hospital, Lahore Pakistan

Emergency TRIAGE Counter

EMO

Pediatric Medicine

Pediatric Specialties

Pediatric Surgery

▪ Discharged ▪ Short Stay ▪ Indoor ▪ ICU

▪ Cardiology ▪ Gastroenterology ▪ Neurology ▪ Nephrology ▪ Endocrinology ▪ Hematology/Onco ▪ Rheumatology ▪ Orthopedics ▪ Urology ▪ Plastic Surgery Neonatology Indoor NICU

COVID -19: Levels of Emergency Triage

1. Identify the COVID-19 Patient: Suspect or Confirmed (PCR) 2. Record Assessment History & Findings 3. Prioritize the patient’s need for medical treatment & transport from the emergency scene: Mild, Moderate, Severe or Critical 4. Track the patient progress through the triage process 5. Identify additional hazards e.g. Contamination i.e. Donning & Doffing

Shock or Circulatory Impairment Airway

• bstruction or

Respiratory Distress

ETAT

COVID-19

Severe Dehydration Altered consciousness Coma or Convulsions

Screening of Patients at arrival: COVID Case definitions

Moderate COVID-19:

• Fast breathing (as per

WHO ARI criteria) with NO chest indrawing

• SPO2 between 90-94%

at room air

• X-ray Infiltrates > 30%
• No Danger signs of

Severe Disease Severe COVID-19

• Fast breathing with

chest indrawing

• X-ray Infiltrates > 50%
• SPO2 <90% in room

air

• Danger signs:

Critical COVID-19

• Respiratory failure

requiring Mechanical Ventilation

• ARDS, Sepsis with Shock
• Drowsy or unconscious
• (MODS) Multiple organ

dysfunction syndrome MIS-C COVID-19 Persistent fever (> 3 days) & ANY TWO of the following: 1.Symptoms like Kawasaki disease

• 2. Shock
• 3. Myocardial dysfunction,

pericarditis, valvulitis, or coronary abnormalities

• 4. Coagulopathy
• 5. GI symptoms (vomiting,

diarrhea, pain abdomen), raised CRP, ESR.

How to Sustain ETAT for COVID & Non-COVID: Restructuring

• Registration
• Screening by

EMO Pt arriving in emergency

• COVID

(Special Area)

• Non-COVID

Triage: On- duty PGR & Consultant

• Mild
• Moderate
• Severe
• Critical

Shift to COVID Isolation If COVID Then Classify

• Assess the

severity

• Any specialty
• pinion

required

If Non- COVID & Any other NCD

• Discharge
• Short Stay
• Admit in

Indoor

Treatment

• General

Medical indoor

• Specialty

Indoor

Separate Defined Routes for shifting

Pediatric Emergency Reorganizing to Sustain ETAT & Triage

Pre & Post COVID-19: Effect on Patient Inflow

10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000

OPD Admissions Acc & Emergency Surgeries

500 1,000 1,500 2,000 2,500 3,000

January April May

NN Emergency Asthma clinic Cardiology Children vaccinated

COVID-19 (3 (30 Confirmed Children)

16.6% 26.7% 36.7% 20% 5 10 15 20 25 30 35 40

<1 yr 1-5 yrs 5-10 yrs 10-15 yrs

Age Groups

15 (50%) 6 (20%) 7 (23%) 2 (7%)

Disease severity

Asymptomatic Mild Moderate Severe

Sustaining high quality Essential Health Services

• ‘Work Force’ distribution: For Non-COVID & COVID 24/7 as required
• Special Fever/Filter Clinics/Specialty Clinics: For Non-COVID & COVID, NCDs etc. diabetes, CHD,

Asthma, pulmonology OPD for chronic lung diseases, Celiac, Nephrology & Neurology clinic

• Auxiliary Services: Reorganized by 2 Separate Lab & separate radiology service plan: Non-COVID &

COVID.

• Continuity of essential critical indoor therapies/services managed e.g. Chemotherapy, dialysis
• Elective surgeries restarted
• Special hospital staff & Community Trainings: Of hospital staff, Webinars for community Pediatricians

& Handbook of COVID

• Dengue Clinic: working parallel to COVID
• Diagnosis & treatment of other infectious diseases like TB is not effected

Challenges in COVID to Sustain Emergency Triage

• Safety of Health care workers
• COVID scare & stigma in society, so hiding of COVID contact or positive reports etc.
• Varied presentation of COVID e.g. GI Symptoms, cardiac (MIS-C), coagulopathy
• NCDs coming with positive COVID RT-PCRs
• Handling of Surgical emergencies without COVID testing
• Grossly effected Targeted referral to pediatric sub-specialties due to Transport

lockdown

• Emergence of Vaccine preventable diseases e.g. measles, diphtheria, pertussis
• Unemployment leading to increase in malnutrition, micro & macro nutrient deficiencies in

children

• Neonatal Mortality
• Child Abuse