COVID-19 Inpatient Workflows

This section gathers ideas about how to integrate Connect Care clinical content into workflows that support care of patients with COVID-19 illness in inpatient settings. Please see the parent COVID-19 Workflows page for information about tasks common to all contexts.

Admission

Risk Assessment

Admission Orders

Admitting Problem and Hospital Problems

An admitting diagnosis is required as part of an admission order (included in admission order sets). If the patient is being admitted for COVID-19 care, be sure to select a COVID-19 related term. This will become the "principal" hospital problem. If the patient is being admitted for a non-COVID-19 primary problem, but additionally is COVID-19 swab positive, be sure to add an appropriate COVID-19 problem to the hospital problem list.

Selecting Clinical Services

Patients with COVID-19 are, as possible, admitted to designated COVID locations, which may be shared by more than one clinical service (e.g., General Internal Medicine and Pulmonary Medicine). Patients with suspected or resolved COVID-19 are typically admitted to an inpatient service befitting their primary hospital problem, but may, due to pandemic pressures, need to be admitted to an alternate specialty. And facility outbreaks can mandate further patient switches in location and service. It is essential that responsible prescribers confirm or correct clinical service attachments for their patients. COVID-19 facility planning tools depend on this information.

Documentation

Once a patient is admitted, clinicians can use special CO VID-19 documentation tools to streamline and standardize progress notes, transfer summaries, consults and discharge summaries. These are easiest to access from the COVID-19 Sidebar.

COVID-19 Problem Overviews

As soon as a COVID-19 related problem is added or activated in a patient's problem list, an interactive text block (".COVIDOVERVIEW" SmartPhrase) can be inserted into the Problem Overview edit box. It can also be added to progress or summative documentation as easy-to-read text. Behind the text is structured data needed to characterize a COVID-19 illness. The text block is dynamic. It has a subtitles and keywords, highlighted in a dark blue font, which can be clicked to re-expose the data form for edits or additions.

COVID-19 Sidebar

An inpatient "Sidebar" is available (right side of screen) within any patient chart opened to an inpatient or emergency context. Upon selecting the "Notes & Reports" index link (bottom of left column of index at top of Sidebar), note a "COVID-19" row within an "Other Sidebar Reports".

The COVID-19 "Acute Sidebar" displays standardized text blocks (together with SmartPhrase mnemonics) so that the current state of key structured information can be reviewed at-a-glance, updated, and included in documentation:

  • COVID-19 Overview
    Key clinical information that should be captured for all COVID-19 patients, including when symptoms started, morbidity risks, functional status, interventions experienced and course of illness.

  • COVID-19 Status
    Summarizes information about infection testing, serology, isolation and immunizations.

  • COVID-19 Markers
    Pulls in key laboratory tests and risk prediction scores.

  • COVID-19 Acute Symptoms
    Lists the most recent observations from a standardized COVID-19 acute symptom tracking flowsheet that is updated daily by team clinicians.

  • COVID-19 Medication Administrations
    Lists all medications received during the current encounter that relate to COVID-19 care.

The COVID-19 text blocks are "interactive". Click on subheadings or any text appearing in a dark blue font for popup data-entry tools. These facilitate quick data entry or edits for the structured data behind the prose.

COVID-19 Symptom Tracking

Nurses and prescribers use a COVID-19 acute symptom tracking flowsheet daily to document observations most likely to reflect progress of acute COVID-19 illness. The easiest way for prescribers to use this information is via the COVID-19 Sidebar (as above). A "COVID-19 Acute Symptoms" (SmartPhrase ".COVIDSYMPTOMSACUTE") section shows the most recent flowsheet entries. Clicking on the section title (or any text in dark blue font) brings up a focused flowsheet view where current symptoms can be entered or reviewed.

The full COVID-19 Symptom tracking flowsheet can be found in the "Flowsheets" activity within an opened patient chart. Look up the "COVID-19 Symptom ID and Monitoring" flowsheet.

Inpatient Care

Pre-rounding

Rounding

Intra-Facility Transfers

Mandatory Isolation

Mandatory Isolation for non-Compliant Patients

Discharge

Follow-up for Pulmonary COVID-19 Complications

Patient Support with MyAHS Connect

Key Guidance Resources for Inpatient COVID-19 Care

Connect Care Updates