Evidence Check - Clinical models of care

Triage, virtual care, temporary hospitals, ethics.

Eating disorders and COVID-19

Added: 23 Aug 2022

What is the impact of the COVID-19 pandemic on the prevalence of eating disorders?
What are the trends in the presentation with eating disorders, especially among children and adolescents?
What are the innovative or new management strategies or pathways to care for patients with eating disorders?
What are the workforce implications and changes in workforce supports required?
  • Increase in the prevalence of eating disorders during the pandemic is attributed both to the worsening symptoms among patients with a prior history, and new onset symptoms and diagnosis in the community.1-5
  • The prevalence of recurring or exacerbated symptoms among patients with pre-existing eating disorders is 57% (meta-analysis of studies with patients with diagnosed eating disorders and who had their mental health disturbances evaluated) during the pandemic.

Alternative models of care for acute medical conditions

Added: 25 Jul 2022

What is the evidence on alternative models of care for managing patients with acute medical conditions outside of emergency or inpatient hospital settings?
  • Evidence generated on alternative models of care is context dependent, particularly with respect to country, organisation and funding, collaboration between hospital, primary care and other community or residential aged care services and patient population. This leads to difficulty in generalising findings.
  • Overall, alternative models of care can be promising in terms of reducing presentations to the emergency department and subsequent admissions, especially for younger and otherwise healthy individuals without comorbidities.

Archive Surgery and COVID-19 - retired living evidence

Added: 14 Jul 2022

What evidence is available about surgery and COVID-19?
  • This evidence table includes information on surgery and COVID-19.
  • It focuses on testing, outcomes, vaccines, workforce, personal protective equipment and aerosol generating procedures.

Rapid access models of care for respiratory illnesses

Added: 17 Jun 2022

What is the evidence for rapid access models of care for respiratory illnesses, especially during winter seasons, in emergency departments?
  • Alternative models of care for acute respiratory illnesses aim to reduce the demand for emergency department and other inpatient hospital services and support patients in the community and at home.
  • Existing alternative models of care include respiratory clinics which respond to referrals from the primary care clinicians or emergency departments and are staffed by specialist respiratory clinicians, pre-hospital emergency pathways which attend to emergency medical calls at homes, acute management and observation services provided by trained general practitioners and nurses, and general practice respiratory clinics for people with low acuity respiratory symptoms.

Post acute and subacute COVID-19 care

Added: 30 Sep 2021
Updated: 11 Feb 2022

What published advice and models of care are available regarding post-acute and subacute care for COVID-19 patients?
  • The burden post severe COVID-19 and prolonged ICU stay is considerable in patients, affecting both functional status and biological parameters, suggesting the need for close follow-up for critically ill COVID-19 survivors.
  • Emerging evidence suggest that age, hospitalisation, a higher number of onset symptoms, history of asthma bronchiale, distinct immunoglobulin signature and an increase of certain inflammatory markers during primary infection are associated with an increased risk of developing post-acute sequalae of COVID-19. A pre-print study suggests that COVID-19 infection may cause microscopic damage to the lungs which may explain the breathlessness experienced by post-acute COVID-19 patients.
  • National COVID-19 Clinical Evidence Taskforce recommendations for the care of people with post-acute COVID-19 encompass assessment, managing infection, diagnosis, red flags and symptoms, as well as goals of care such as communication, access and coordination.

Archive Acute mental health inpatient unit risk mitigation and models

Added: 8 Oct 2021

What are the published risk mitigation and models of care for COVID-19 positive people in an acute mental health inpatient unit or in the community?
  • A systematic review identified four themes for reorganising psychiatric facilities to reduce transmission risk: addressing people’s higher risk of infection, organising to prevent clusters, implementing multiple adaptions in facilities and setting up extra-psychiatric care structures.
  • International examples of care delivery models for COVID-19 positive people with a lived experience of mental health issues include: - In the United States, a free-standing psychiatric hospital was re-purposed for treating COVID-19 in people requiring inpatient psychiatric treatment. Bed capacity, source of referral, personal protective equipment, admitting process, team structure, medical and psychiatric management, disinfecting the unit and other factors are described in how to operationalise the psychiatric COVID-19 unit. - Also in the United States, a medical centre created a stand-alone unit to care for COVID-19-positive people with acute psychiatric needs, while minimising the risk of exposure to other patients and staff using a three phase approach: identifying an existing unit, moving patients, and creating the administrative, staffing, and clinical infrastructure.- A case report in the United States described a COVID-19 positive person, who presented to the emergency department, who had his psychiatric treatment conducted via phone and through a glass wall. - In Israel, a dedicated psychiatric hospital has 16 beds specifically dedicated to treating people with both acute psychiatric needs and COVID-19. Two-way communication technology was installed, enabling people to speak to therapists and family members from a safe distance. - A dedicated setting was established in India. They considered several factors to reduce transmission risk, including modifications to admission procedures, criteria for admission and discharge, logistics of management while admitted, transfer and discharge and readmission.6 Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health. - An inpatient unit in Turkey for people with COVID-19 included measures such as cameras in rooms for observations, hospitalisation with a companion, daily visits and medical treatments for people with COVID‐19 being conducted after daily consultations with the Department of Infectious Diseases.
  • The American Psychiatric Association Committee guidance suggests vaccines should be prioritised for people with substance use disorders and serious mental illness.8 People should be provided with information about the benefits of vaccination, and vaccination rates in people with mental illness can be increased with targeted strategies such as vaccination programs in clinics.
  • Uptake of COVID-19 vaccination in a medium secure psychiatric hospital population in the United Kingdom was high (85 of 92 patients).10 However a mental health hospital in Israel had 51 of 196 people sign the informed consent for vaccination.11 A large university psychiatric hospital in Belgium found COVID-19 vaccination rates in people with mental disorders, admitted to or residing in a psychiatric hospital, were as high as in the general population with a targeted prevention program.

Archive Oxygen saturation monitors/pulse oximeters for COVID-19

Added: 29 Sep 2021

Evidence on oxygen saturation monitors/pulse oximeters for COVID-19
  • Remote home monitoring models for COVID-19 aim to manage high-risk patients at home to avoid unnecessary hospital admissions and escalate cases of deterioration in a timely way. Oxygen (O2) saturation monitors, or pulse oximeters, can be used at home to detect COVID-19 associated hypoxia.
  • Home oximetry requires clinical support, such as regular phone contact from a health professional in a virtual ward setting.
  • Symptoms of COVID-19 can range from mild illness to pneumonia. Most people experience mild illness and can recover at home. Treatment is aimed at relieving symptoms and includes rest, fluid intake and pain relievers. However, there are a variety of COVID-19 disease trajectories, and care at home requires assessment of risk and monitoring of changes in clinical parameters.
  • Oximetry has been identified as an important element in providing home care for COVID-19 patients and monitoring the need for escalation.
  • The UK Medicines and Healthcare Products Regulatory Agency does not recommend the use of oximeters at home unless under the advice of a qualified clinician. Pulse oximeters are regulated as medical devices.
  • The NHS recommends ensuring any pulse oximeter used at home has a valid CE, UKCA or CE UKNI mark. They have a patient leaflet on how to use a pulse oximeter.
  • In the US, pulse oximeters are regulated by the Food and Drug Administration (FDA).5 Pulse oximeters reviewed by the FDA are only available with a prescription and may be prescribed for home use. Over-the-counter oximeters do not undergo FDA review.
  • There is limited data on the accuracy of inexpensive pulse oximeters, including stand-alone finger oximeters and phone-based products.
  • An observational study during COVID-19 found that low-cost pulse oximeters sold to consumers may produce inaccurate readings, although some perform similarly to more expensive options.

Archive Organisation of emergency departments during COVID-19

Added: 20 Sep 2021

What is the evidence to support surging the capacity of emergency departments (EDs) during the COVID-19 pandemic in terms of: infrastructure, staffing, processes and patient flows, including flows out of ED
  • International examples of hot and cold zones are well described. Core characteristics of designated (hot and cold) zones include designated physical areas, certain personal protective equipment requirements, staffing models and screening areas to separate patients with known or confirmed COVID-19 from those without suspected COVID-19.
  • Temporary hospitals such as tents and marquees as well as repurposing other buildings and COVID-19 designated hospitals have been used internationally for triage and treatment.
  • Restructuring of teams and dedicated shifts have been used to reduce the number of staff exposure to COVID-19, while using other specialties has been implemented for surge capacity.
  • Patient flows and patient cohorting have been used in triage and to alleviate bed shortages.

Daily Evidence Digest

Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health.

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