{"id":4009,"date":"2020-07-29T14:03:57","date_gmt":"2020-07-29T18:03:57","guid":{"rendered":"https:\/\/www.bumc.bu.edu\/id\/?page_id=4009"},"modified":"2020-12-09T09:52:21","modified_gmt":"2020-12-09T14:52:21","slug":"clinical-algorithms-for-admission-and-discharge","status":"publish","type":"page","link":"https:\/\/www.bumc.bu.edu\/id\/covid-19-response\/clinical-algorithms-for-admission-and-discharge\/","title":{"rendered":"Clinical Algorithms for Admission and Discharge"},"content":{"rendered":"<ul><\/ul>\n<h3 style=\"text-align: center;\"><strong><a href=\"\/id\/files\/2020\/12\/COVID19_Clinical-Criteria-for-discharge.2020.12.2.pdf\">COVID19_Clinical Criteria for Discharge updated Dec 2, 2020<\/a><\/strong><\/h3>\n<p style=\"text-align: center;\"><strong><u>Main clinical criteria for discharge to home<\/u><\/strong><\/p>\n<ol>\n<li>Overall improvement in the fever curve without antipyretics. No fever spikes \u2265 101 F for \u2265 48 hours<\/li>\n<li>Improved or stable respiratory symptoms (e.g. improved shortness of breath or cough) and improved or stable oxygen requirement for \u2265 48 hours<\/li>\n<li>Improved or stable laboratory data including inflammatory markers if they were followed during the admission (especially C-reactive protein, ferritin and lactate dehydrogenase)<\/li>\n<\/ol>\n<p style=\"text-align: center;\"><strong><u>Additional comments<\/u><\/strong><\/p>\n<ul>\n<li>When making a decision to discharge a patient, the team should include time since onset of initial symptoms. Patients within 6-9 days since symptom onset are at highest risk for<\/li>\n<li>All known COVID-infected patients with no PCP or with a BMC PCP who are discharged home\u00a0will automatically receive at least one follow-up call within 24-48h of discharge to assess for symptoms. Community health centers (CHC) patients have a separate workflow; please notify the CHC in question at the time of discharge.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"30\">o<\/td>\n<td width=\"558\">Working phone and up-to-date contact information on Epic<\/p>\n<p>(please note that clinicians can now modify the demographics section to update phone numbers)<\/td>\n<\/tr>\n<tr>\n<td width=\"30\"><\/td>\n<td width=\"558\">Information on primary care team up-to-date on Epic<\/td>\n<\/tr>\n<tr>\n<td width=\"30\"><\/td>\n<td width=\"558\">Appropriate home setting<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Patient can adhere to home isolation (separate bedroom)<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 No household members are either pregnant, immunosuppressed, or have a history of end-stage renal disease<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Appropriate caregivers are present in the home, if applicable<\/p>\n<p>\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 For patient experiencing homelessness, please follow separate guidelines providing guidance for this group<\/td>\n<\/tr>\n<tr>\n<td width=\"30\"><\/td>\n<td width=\"558\">Quarantine education provided at discharge to patient and family. Patient and family have access to face covering, and patient has surgical mask for transport.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p style=\"text-align: center;\"><strong><u>Special considerations\/populations<\/u><\/strong><\/p>\n<ul>\n<li><strong>COVID positive\/high probability patients experiencing homelessness who leave against medical advice (AMA): <\/strong><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Monday through Friday from 7 AM to 7 PM: Contact Deanna Faretra (pager 0735) who will coordinate with Boston Public Health Commission (BPHC)\u2019s Homeless Services Bureau and BMC Infection Control. \u00a0Deanna is also a resource for patients who are contemplating leaving AMA.<\/li>\n<li>Nights and weekends: The floor team should call BPHC\u2019s Homeless Services Bureau at 617-645-9680 as soon as possible and email BMC infection control (DG-HospitalEpidemiology and cc: Deanna.Faretra@bmc.org).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"text-align: center;\"><strong><u>Testing considerations at Discharge<\/u><\/strong><\/p>\n<p>Please see the BMC protocol on \u201cCOVID-19 Removal of Isolation Precautions PUI and COVID-19 patients\u201d for access to updated and full guidance.<\/p>\n<p>&nbsp;<\/p>\n<h3 style=\"text-align: center;\"><a href=\"\/id\/files\/2020\/12\/Admission-criteria.update.2020.12.2.pdf\">Admission criteria updated Dec 2nd 2020<\/a><\/h3>\n<p><strong><u>Consider<\/u><\/strong> <strong><u>hospital<\/u><\/strong> <strong><u>admission<\/u><\/strong> <strong><u>for<\/u><\/strong> <strong><u>the<\/u><\/strong> <strong><u>following<\/u><\/strong> <strong><u>findings<\/u><\/strong><strong><u>:<\/u><\/strong><\/p>\n<ul>\n<li><span> <\/span>Any patient with dyspnea or increase respiratory rate <span>(<\/span><span>\u2265<\/span><span>30 breaths <\/span><span>per<\/span> <span>min<\/span><span>)<\/span><\/li>\n<li><span> <\/span><span>Any patient with oxygen<\/span> <span>saturation\u2009\u2264\u2009<\/span><span>94% <\/span><span>on<\/span> <span>RA or <\/span>decrease in saturation to &lt; 90% with ambulation<\/li>\n<li>Overall clinical concern by ED attending for risk of outpatient failure based on high risk for complications from severe COVID-19<\/li>\n<\/ul>\n<p><strong><u>Patients at high<\/u><\/strong> <strong><u>risk<\/u><\/strong> <strong><u>for<\/u><\/strong> <strong><u>complications<\/u><\/strong> <strong><u>from<\/u><\/strong> <strong><u>severe<\/u><\/strong> <strong><u>COVID<\/u><\/strong><strong><u>-19<\/u><\/strong><\/p>\n<ul>\n<li>Established risk factors:<\/li>\n<\/ul>\n<p>Age 65 years or older, serious cardiovascular disease (heart failure, coronary artery disease, cardiomyopathies), chronic obstructive pulmonary disease, diabetes, malignancy, obesity (BMI \u226530 kg\/m<sup>2<\/sup>), chronic kidney disease, immunocompromised state with solid organ transplantation, recipient of immunosuppressive therapy, pregnancy and sickle cell disease.<\/p>\n<ul>\n<li>Possible risk factors:<\/li>\n<\/ul>\n<p>Asthma (moderate to severe), cerebrovascular disease<\/p>\n<p><strong><u>Criteria<\/u><\/strong> <strong><u>for<\/u><\/strong><strong><u> safe <\/u><\/strong><strong><u>discharge<\/u><\/strong> <strong><u>to<\/u><\/strong> <strong><u>home<\/u><\/strong> <strong><u>from<\/u><\/strong> <strong><u>the<\/u><\/strong> <strong><u>ED<\/u><\/strong><strong><u>:<\/u><\/strong><\/p>\n<p>None of admission criteria listed above AND<\/p>\n<ul>\n<li>Reliable phone number where the patient could be reached for post-discharge follow-up<\/li>\n<li>Ability to understand and follow self-isolation recommendations\n<ul>\n<li>Patient and family members with access to face covering at home<\/li>\n<li>Food security (enough for time in isolation, or ability to have someone procure it)<\/li>\n<li>Ability to care for own ADLS without assistance from someone outside their household<\/li>\n<\/ul>\n<\/li>\n<li>No household members who are either pregnant, immunosuppressed or have a history of end-stage renal disease<\/li>\n<li>Meds-to-bed for required medications (new or chronic meds needing extra doses)<\/li>\n<\/ul>\n<p>If the patient is being discharged and you would like the patient to be contacted by the COVID-infected follow up monitoring program, please select \u201cCOVID-19 Follow Up\u201d under the \u201cNurse Follow Up\u201d section of DISPO.<\/p>\n<p><strong>If the patient does not meet criteria for safe discharge home, please contact Social Work for help with disposition planning<\/strong><strong>.<\/strong><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>COVID19_Clinical Criteria for Discharge updated Dec 2, 2020 Main clinical criteria for discharge to home Overall improvement in the fever curve without antipyretics. No fever spikes \u2265 101 F for \u2265 48 hours Improved or stable respiratory symptoms (e.g. improved shortness of breath or cough) and improved or stable oxygen requirement for \u2265 48 hours [&hellip;]<\/p>\n","protected":false},"author":10993,"featured_media":0,"parent":3992,"menu_order":6,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/www.bumc.bu.edu\/id\/wp-json\/wp\/v2\/pages\/4009"}],"collection":[{"href":"https:\/\/www.bumc.bu.edu\/id\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.bumc.bu.edu\/id\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/id\/wp-json\/wp\/v2\/users\/10993"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/id\/wp-json\/wp\/v2\/comments?post=4009"}],"version-history":[{"count":6,"href":"https:\/\/www.bumc.bu.edu\/id\/wp-json\/wp\/v2\/pages\/4009\/revisions"}],"predecessor-version":[{"id":4277,"href":"https:\/\/www.bumc.bu.edu\/id\/wp-json\/wp\/v2\/pages\/4009\/revisions\/4277"}],"up":[{"embeddable":true,"href":"https:\/\/www.bumc.bu.edu\/id\/wp-json\/wp\/v2\/pages\/3992"}],"wp:attachment":[{"href":"https:\/\/www.bumc.bu.edu\/id\/wp-json\/wp\/v2\/media?parent=4009"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}