Practitioner Virtual Q&A - Week: May 5 to May 8, 2020 - Government of Saskatchewan
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
COVID-19 Practitioner Virtual Q&A Week: May 5 to May 8, 2020
Topics to be covered: 1. Weekly Physician Wellness Boost & Training Opportunity 2. Daily Dashboard & Public Health Orders 3. New Clinical Orders/Updates 4. Service Resumption Planning for the Saskatchewan Health Authority 5. Guidelines for Re-opening Community Clinics (where appropriate) 6. COVID Pathway 7. System Flow Coordination Centre Update 8. SMA Update 9. Pandemic Physician Services Agreement Update 10.CPSS Update 11.Continuing Medical Education Opportunities 12.Physician Information & Communication 13.Questions & Answers
Weekly Physician Wellness Boost
Weekly Physician
Wellness Boost
Minding Your Mood Amidst COVID-19 – Dr. Andriyka Papish
Minding Your Mood Amidst COVID-19: Preview / Full
(available on the physician wellness and support page)
Physician Wellness Support Contacts:
Saskatchewan Medical Association Physician Health Program
Saskatoon, NE, NW: Brenda Senger
306-657-4553
Regina, SE/SW: Jessica Richardson
306- 359-2750
Daily Dashboard and Public Health Orders
Daily Dashboard
(May 5, 2020)
As of May 5, there
are 20 new
confirmed cases,
bringing the total to
487 reported cases
of COVID-19 in
Saskatchewan.
COVID Screening Updates
April 30-May 3, 2020
• A Pandemic Screening Working Group has been formed to develop
evidence-based processes for patients, health care workers, and
caregivers/care partners that balance sensitivity and specificity
according to clinical context.
• New Screening Tools for 1) Acute, 2) Hemodialysis & 3) ER Rapid Triage:
1 2 3
https://www.saskatchewan.ca/- https://www.saskatchewan.ca/-
https://www.saskatchewan.ca/- /media/files/coronavirus/info-for-health-care-
/media/files/coronavirus/info-for-health-care- /media/files/coronavirus/info-for-health-care-
providers/testing-screening-and-medical-
providers/testing-screening-and-medical-directives/sha- directives/screening/sha-0036-covid-19-hemodialyis- providers/testing-screening-and-medical-directives/sha-
0002-covid-19-in-facility-screening-tool.pdf screening-tool.pdf 0004-covid-19-ed-rapid-triage-screening-tool.pdf
REMINDER! What to do if YOU screen
“UNFIT to work”?
• Self-isolate
• Contact your
manager/
Area
Department
Lead/
Program
Director
• Call OHS:
1-833-233-4403
Email: OHS_Healthcareworkers_COVID19@saskhealthauthority.ca
New Clinical Orders/Updates
Maternal and Children Updates
Three NEW Work Standards to reduce and contain the spread of influenza-like
illness (ILI) (such as COVID-19) while supporting the direct and unique needs of
maternal and child populations. These work standards outline how best to protect
patients and health care providers through the responsible evidence-based
utilization of personal protective equipment (PPE) and provides principles to guide
the practice within Saskatchewan, each clinical program/unit will be required to
adopt the principles into established and monitored local plans and practices.
1
Postpartum and Newborn Care Standard for COVID-19: CV-19 WS0019
Postpartum and Newborn Care Standard for COVID-19
2 Antepartum Care Standard for COVID-19: https://www.saskatchewan.ca/-
/media/files/coronavirus/info-for-health-care-providers/clinical-pratice-resources/maternal-childrens-
health/cv-19-ws0020-antepartum-care-standard-for-covid-19.pdf
3 Intrapartum Care Standard for COVID-19:
https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-
providers/clinical-pratice-resources/maternal-childrens-health/cv-19-ws0021-
intrapartum-care-guidelines-for-covid-19.pdfNEW Protocol for Operative Management of
Pediatric Surgical Patients during COVID-19
Pandemic (April 28, 2020)
PLUS! new order
sets as follows:
• SHA OS-010
NICU/Newborn Care
Admission (April 24, 2020)
• SHA OS-011 PEDIATRIC
Admission Orders (April
24, 2020)
• SHA OS-012 Obstetrics
Antepartum Orders (April
24, 2020)
• SHA OS-014 Obstetrics
Intrapartum Orders (April
24, 2020)
https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-providers/clinical-
pratice-resources/maternal-childrens-
health/cv19g0021protocolforoperativemanagementofpediatricsurigicalpatientsduringcovid19pandem
icapril282020.pdfThe latest Rapid PPE Updates
Gloves are NOT for Ear protectors &
continuous use Masking
For the latest
updates visit
www.saskatchewan.ca/covid-19
as these PPE
updates get added
frequently
April 23: https://www.saskatchewan.ca/- April 23: https://www.saskatchewan.ca/-
/media/files/coronavirus/info-for-health- /media/files/coronavirus/info-for-health-
care-providers/ppe/ppe-rapid-update- care-providers/ppe/ppe-rapid-update-ear-
gloves-are-not-continuous-use-final.pdf protectors-final.pdfUpdated PPE Guidelines for Acute and
Continuous Care
These two documents provide recommendations for Continuous* face mask use
and Extended** use of face masks and eye protection.
*Continuous face mask use: all healthcare workers who come into contact with
residents during the course of their shift must wear a face mask at all times.
**Extended use of face masks and eye protection: is the practice of wearing the
same face mask and eye protection for repeated interactions with multiple
residents for the maximum of one complete shift.
1
Continuous And Extended PPE Use Guidelines Acute Care: CV-19
G0006 Continuous And Extended PPE Use Guidelines Acute Care (April 30, 2020)
2 Continuous And Extended PPE Use Guidelines Continuous Care :
CV-19 G0007 Continuous And Extended PPE Use Guidelines Continuing Care (April 30, 2020)News release: Medical Care is Safe to Access (May 4, 2020) This week the Saskatchewan Health Authority issued a press release to remind all Saskatchewan residents that if you feel unwell and think you require any medical care, don’t wait. Accessing medical care in the midst of COVID-19 is safe whether you visit your local walk-in clinic, family physician, etc. https://www.saskhealthauthority.ca/news/releases/Pages/2020/May/Medical-Care-is-Safe-to-Access.aspx
Saskatchewan Health Authority’s Resumption of Services
RESUMPTION OF SERVICES
Released: May 5, 2020
www.saskatchewan.ca/COVID19
https://www.saskatchewan.ca/government/news-and-
media/2020/may/05/shas-service-resumption-planConsiderations
• Our focus is on everyday health services – those that help Saskatchewan
residents stay healthy and live well, receiving care as close to home as
possible.
• New ways of working are an important consideration. Online programs
and virtual care have become essential to our services and will continue to
be central to delivering care across the province.
• We need to adapt and expand to:
• prevent community transmission of COVID-19
• meet the projected COVID-19 patient demand, while
• continuing to deliver services to non-COVID-19 patients throughout
the duration of the event.
saskatchewan.ca/COVID19Phases
Phase 1: Resume some everyday services & expansion of surgeries and
diagnostic imaging (timing = May 19, 2020)
Phase 2: SHA-operated specialty clinics (timing = TBD)
Phase 3: Further expansion of everyday services (timing = TBD)
Phase 4: Full resumption of services (timing = TBD)
Important: Implementation will vary across the province depending on
• Outbreaks
• Capacity
• Ability to adhere to Public Health Orders
• Timing between stages will be considered carefully
saskatchewan.ca/COVID19Triggers Resumption triggers • Staff availability • Physician availability • Supply chain availability • Current capacity Slowdown triggers • Prioritization to maintain COVID-19 related services • Increase of COVID-19 positive patients in hospital • Re-deployment of staff • Workforce illness impacts • Supply chain availability • Public health orders • Community transmissions • Community outbreak • Possible fire or flood disasters saskatchewan.ca/COVID19
Phase 1
Surgical Services • Phased expansion of surgeries from three week urgent
and emergent cases to six week urgent cases
• ex. Cataracts, hysterectomy, cochlear, thoracic
• 75% day surgery and 25% inpatient surgery
Diagnostic Imaging • Increase outpatient volumes
• ex. MRI, CT, X-Ray, Ultrasound
Endoscopy • Continue for urgent and symptomatic patients
• Colorectal screening and positive FIT tests
Ambulatory Care • Expand urgent minor surgical procedures
• ex. breast biopsies
• Pre-operative clinics
• Expand outpatient urgent infusions
Physical Medicine, • Outpatient clinics
Rehabilitation and • Orthotics and prosthetics services
Therapies • Outpatient orthopedic and neuro therapy
• Adult day/wellness programming
saskatchewan.ca/COVID19Phase 1
Primary Care Clinics • Expand availability of everyday health services within
communities
• ex. chronic disease support, baby care, prenatal care
• Continue to use virtual appointments, where appropriate
• Prioritized in person visits for those living with chronic diseases
Home Care • Moderate risk client needs will be prioritized
• Home care nurses facilitate virtual appointments with
physicians
• Bathing services
Public Health • All routine immunizations
Nursing • Reintroduce face-to-face visits for vulnerable clients
• Infant/mother post-birth programming and breastfeeding
clinics
Public Health • Prioritize high risk inspections
Inspections • Enforcement of adherence to public health measures
• Increase inspections of LTC, Personal Care Homes, Group
Homes
saskatchewan.ca/COVID19Phase 1
Maternal/Child • Expand outpatient and developmental pediatric clinics
Kidney Health • Home-based dialysis therapies training and in-person
satellite hemodialysis visits
• Recipient work-up, listing and transplants
Mental Health & • Provide the option of in-person appointments as needed.
Addictions • Therapeutic and day programing for groups ofPhase 2
SHA-Operated specialty clinics:
• Continue with virtual care where possible
• Electrophysiology, cath lab, cardiac stress testing, outpatient
heart monitoring
• Respiratory:
• Level 3 sleep disorders testing
• Respiratory Outpatient Clinic
• Tuberculosis Clinic and treatments
• Eye centre testing
• Dermatology clinics
• Cast clinics
• High risk antenatal clinics
• Increase fetal testing
saskatchewan.ca/COVID19Phase 3 - Everyday Health
Services
• Chronic Disease Management/Wellness Programs/Stroke Prevention
• LiveWell with Chronic Conditions
• Heart health programs
• Opioid Agonist Therapy
• High priority/risk clients seen face to face and screening for all clients
• Increase the amount of carries that vulnerable clients have access to
• Mental Health and Addictions
• Continued expansion of services
• Opening of social detox and addictions inpatient treatment
• Learner placements
• Plan for fall/winter semester for all health science learners
• Specialized services for clients with developmental disabilities, Autism and
brain injuries
saskatchewan.ca/COVID19Surgeries and Procedures
All remaining services and procedures to resume ‘normal’
operations, including
• Surgical Services
• Addition of long-waiting electives and previously
postponed surgeries
• Orthopedics
• Re-open hip/knee outpatient clinic
saskatchewan.ca/COVID19Guidelines for Re-Opening Community Clinics
New memo: Guidelines for Re-Opening
Community Clinics (May 4, 2020)
In response to the Government of
Saskatchewan’s Re-Open Saskatchewan
Plan, SHA has created guidelines for
Community and Family Physicians during
the first phase of re-opening including:
• General Information: professional guidelines, PPE, Masking &
Screening guidelines, Virtual Care options, self-screening, etc.
• Patient Considerations: Patient Bookings, Clinic Considerations,
Cleaning and Disinfection, Worker Health/Preventative
Measures, Resources, etc.
https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-providers/information-for-
physicians/community-and-family-physicians/guidelines-for-opening-community-clinics.pdfCOVID Pathway https://www.saskatchewan.ca/government/health-care-administration-and-provider-resources/treatment-procedures-and-guidelines/emerging-public-health- issues/2019-novel-coronavirus/information-for-health-care-providers/clinical-practice-resources/covid-19-pathway
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
Resources capabilities are available on the COVID-19 website. An inventory
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 Pathway Acute Care
COVID-19 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.
COVID-19 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.
COVID-19 Acute Care Pathway
Key Supporting Initiatives
Coordinated Patient Includes role descriptions of COVID-19 ready facilities and EMS
Flow Plans Bypass Protocols.
System Flow Provides centralized support to inform decision-making in primary
Coordination Centre care and small hospitals, as well as administrative support for
(SFCC) decisions about patient disposition and transport destinations.
Critical Care, Medicine and Emergency order sets have been
developed. Other COVID-19 related order sets have been created
COVID-19 Order Sets
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 Identify and support through training and simulation designated
Intubation Hubs sites that will serve as intubation hubs throughout the province.COVID-19 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.
https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care- providers/clinical-pratice-resources/covid-19-pathway/visuals-of-the-pathway/acute-care- pathway.pdf
COVID Pathway Community Care
COVID-19 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.
COVID-19 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 CareVisual
https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-
providers/clinical-pratice-resources/covid-19-pathway/visuals-of-the-
pathway/community-care-pathway.pdfVulnerable 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.COVID Pathway 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
We will continue to advance this
work by:
COVID-19 • Identifying intermediate care
requirements and resources to address
Pathway needs.
• Engaging in post-acute care planning
Next Steps for continuing care residents who may
require acute care services.
This information (PLUS MORE!) • Establishing deeper connection points
posted on website: for contact tracing and monitoring to
https://www.saskatchewan.ca/govern prevent the spread of the virus.
ment/health-care-administration-
and-provider-resources/treatment- • Incorporating linkages with pathology
procedures-and-guidelines/emerging- for management of the deceased if
public-health-issues/2019-novel- demand exceeds capacity.
coronavirus/information-for-health-
care-providers/clinical-practice- • Linking it to the Connected Care
resources/covid-19-pathway strategy.System Flow
Coordination Centre
Update
https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-providers/clinical-pratice-resources/covid-19-pathway/sfcc-combined-memo.pdfGoal Statement System Flow Coordination Center • A high quality provincial traffic control service • Urgent physician access line • Urgent consults related to admissions/ transfer support
What is the response to what we’re
hearing?
• SFCC sponsor physician co-lead established
• Setting up SFCC steering committee with admin leaders,
provincial heads, ACOS representation
• Continuous improvement cycles
• Temporary Safety Measure:
• Creating capacity by asking Saskatoon physicians to use switchboard for
internal consults not resulting in admission/transfer where safe to do so
• Physician discretion on when to use Switchboard
• Meet the needs of in-house consults in Saskatoon in alternate
way
• Written communication (Marjorie Ingjaldson and Dr. Phillip
Fourie)
• Within next 1-2 days with more details to physiciansOur Commitment: • Critical Care Calls • answered in real time with no delays • Urgent calls • answered with minimal delay • goal is live on the calls • Continuous improvement in Service • Partnership with physician leaders to address concerns together
If you have concerns: New email to use to send in detailed concerns: SFCC.LeadershipTeam@saskhealthauthority.ca
SMA
SMA Update (as of May 4, 2020)
“It is never too late to be who you might have been.”
Please do not hesitate to reach out to the Physician Health Program
Brenda Senger Jessica Richardson
(Saskatoon/North) (Regina/South)
306-657-4553 306-359-2750
• Physician Training for Peer Support Skills, May 5th & 7th . Interested?
Contact covid19.psychosocialsupport@saskhealthauthority.ca
• Helpful site: https://ca.ctrinstitute.com/ . Lots of excellent resources.
• SMA’s Physicians Saying Thank You! Campaign
https://vimeo.com/413648531/d76da198c5SMA Update (May 4, 2020)
• Pandemic Compensation Policy
• Self-Isolation Benefit. More information in this week’s Practice Alerts
• Navigating COVID-19: Considerations, Assistance and Resources
• Virtual Information Session on Provincial/Federal Programs and Financial
Considerations for Physicians. Hosted by MD Scotia Bank
• May 12th @7:00 PM. Registration required.
• More information in this week’s Practice Alerts
• CMA https://www.cma.ca/physician-financial-guidance-MNP
• PPE
• Option of online ordering PPE Supplies is now available for all private,
community-based physicians. https://www.schaanhealthcareproducts.ca/
• General inquiries? sma@sma.sk.caPandemic Physician Services Agreement Update
Pandemic Physician Services
Agreement Update
Total requested:
Total fully executed/ pending physician signature:
Total to be executed:
Declined or did not qualify:
Questions?
Email: contract@saskdocs.ca
Phone: 306-933-5000CPSS
CPSS Update • Guidance document on Virtual Care delivery available on the CPSS website. • The College website now has a listing of important communications in the physician section. • The College is available for assistance, questions or concerns – Contact Us on our website.
COVID-19 CME Opportunities University of Saskatchewan (Continuing Medical Education)
Continuing Medical Education
College of Medicine
Supporting you now and beyond the
COVID-19 Pandemic
https://cmelearning.usask.ca/CME: Where we were
In person Conferences Other Programs
SEMAC SIPPA Program
Pediatrics (inaugural 2020) IMG program
Pain & Therapeutics
Perinatal Program
Orthopedics
Older Adults Indigenous Wellness
SaskSono CanREACH SK (launch 2020)
Choosing Wisely On-Line Learning & Assessment
Heart Disease & Stroke Supporting Departments and
Oncology Divisions at the College of Medicine
Disordered eating (inaugural 2020)
Wellness Program (launch on hold)
Educated Care is Better CareCME: Where we are-”the pivot”
Webinar Wednesdays 6-8 PM Other engagements
Past programs Internal Medicine Bootcamp
a) Infectious Diseases, OB/Gyn, ER, Supporting the SHA
Peds/Geriatrics a) Task Force Physician Upskilling
b) Provincial Dept Needs Assessment
Future Sessions c) Gary Groot COVID-19 evidence
a) Ethics-Difficult Decisions d) Wellness-(Anita Chakravarti)
b) Wellness COVID-19 Resource Center
c) Managing Addictions & COVID-19 https://cmelearning.usask.ca/covid-
d) Family Practice during COVID-19 19/covid-19-information.php
On line learning/assessments
Educated Care is Better CareCME: Where we’re going (forward together)
Right now-buy your CPD locally! Our Future
On line learning-enhanced Conference Hybrid format
a) Webinars-expansion? a) both in person and remote learning
b) Fitness to Drive b) Large groups
c) Indigenous Wellness c) Small group sessions
d) Pain & Therapeutics d) Workshops
e) ER Clinical Imaging module (new!) e) Regular webinars to support
f) Choosing Wisely communities of practice
Linking Learning to Practice, Cancelled conferences:
Research, Assessment, Teaching, a) Transform previous elements into on
Administration line opportunities?
Questions? : cme@usask.caWhere do I find information?
Contract questions –
contract@saskdocs.ca
or call 306-933-5000
Physician
Information • Physician specific
section on website:
www.Saskatchewan.ca/
covid-19
• Regular Physician
Virtual Town Halls –
provincial summaries
@SaskHealthAuthority
posted on the website
each week!
@SaskHealth
• SHA daily rounds emailsQ&A Please enter your question in the Q&A section OR Raise your hand and we will unmute you so you can comment or ask your question live
You can also read
