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COVID Ward Model of Care Update
All Employee Forum
27 October 2020
2
Victoria is seeing a reduction in new daily cases of COVID-19 with a
corresponding reduction in active cases in the community…
Source: www.dhhs.vic.gov.au/victorian-coronavirus-covid-19-data, 26/10/20
… we are reintroducing non-essential
elective surgery and other planned
activity across Monash Health as per
Department of Health and Human
Services guidelines…
3
By the Numbers
187 total admissions
▪ 16 deaths
▪ Low ICU demand
▪ Reducing inpatient demand
▪ Steady testing across our
Screening and Drive Thru
Clinics
Currently we have:
▪ 2 COVID positive inpatients
▪ No COVID positive inpatients
in ICU
▪ No current COVID positive
RACF resident inpatients
Source: BI portal, COVID monitoring report, 27/10/20
4
The impact of COVID on our workforce has stabilised…
▪ One HCW with current COVID positive disease
▪ Five HCWs currently furloughed due to COVID exposure with the majority due to return
from furlough next week
Source: BI portal, COVID monitoring report, 27/10/20
5
Despite a reduction in COVID positive test results and COVID positive
admissions…
Source: BI portal, COVID monitoring report, 27/10/20
… We still have high numbers of suspected COVID patients through our
admission wards… and this will continue…
Only 1% of >5,000 patients
screened for COVID have
returned a positive result at
Monash Health
!
Source: BI data warehouse, 26/10/20
6
We have had low numbers of HCWs with workplace-acquired COVID
disease; a low number of these have been associated with identifiable risk
factors
▪ Care of a patient not recognized as COVID
▪Elderly, deterioration on ward, MET calls
▪ Care of patient with high care requirements
▪Nursing home residents/physically combative
▪ Close contact of an unrecognized positive employee
▪Employee areas, tearooms, less PPE
Risk factors do not include ICU, theatre, ED and COVID Admission wards!
7
Additional Gen Med teams stood up at each site
39 employees redeployed to date (19 units impacted)
Significant roster gaps with increased elective demand
Medical resourcing
Risk of burnout for employees on COVID
Admission wards
HCW fatigue
Multiple bed moves adversely impacts progression of care
Progression of Care
In the setting of low-COVID positive disease, our current Model of Care is not
sustainable long term…
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Main Changes to the Model
▪ Admission wards will no longer exist
▪ New SCOVID terminology:
▪ SCOVID - Low Risk
▪ SCOVID - Probable (high risk)
▪ SCOVID - Low Risk patients: manage in usual care wards to improve
continuity of care
▪ COVID Positive and SCOVID - Probable patients: continue to cohort in
Management Wards
1
2
3
4
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All SCOVID Patients Will
Require Risk Stratification by
Medical StaffSCOVID Probable versus SCOVID Low Risk
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SCOVID – “PROBABLE” Definition
A person who has a compatible clinical illness and meets one or more of the
following epidemiological criteria:-
In the past 14 days prior to illness onset:
▪ Was a close contact of a confirmed or probable case
▪ Travelled internationally
▪ Resided in an area where outbreaks are present, including aged care*
▪ Lived in or travelled through a geographically localised area with elevated
risk of community transmission, as defined by public health authorities*
* This data will be updated and provided daily
11 Important Updated COVID terminology
Term Description Location / PPE
Non-COVID No epidemiological risk factors or clinical
suspicion of having COVID disease
BAU– Tier 1
SCOVID
(low-risk)
Swabbed for COVID and awaiting a test result,
where there are symptoms that could be
consistent with COVID but no epidemiological
risk factors
BAU– Tier 2*
Single room if available
Able to be cohorted with other SCOVID-low risk
and non-COVID patients (via agreed escalation
process)
SCOVID
(probable)
High Risk
Swabbed for COVID and awaiting a test result
and
Epidemiology and demonstrated symptoms
consistent with COVID disease
COVID Management Ward – Tier 3
Single Room until confirmed diagnosis
COVID
Positive
Confirmed COVID disease COVID Management Ward – Tier 3
Able to be cohorted with other COVID positive
*Unless Aerosol Generating Procedure or Aerosol Generating Behaviour (Tier 3)
12 Infection prevention team have worked with ward areas and developed revised
SCOVID patient management practices
Utilise single rooms where available1
Develop shared bathroom model as appropriate2
Dedicated employees on a shift / ward (NS) as appropriate3
4 Appropriate level of PPE utilised for each patient as per MH policy
5Individualise PPE coach / advisor / concierge support allocation per ward configuration
based on demand• Resource embedded in workforce profile for wards with high suspected COVID demand
• Roving teams in areas with low suspected COVID demand
13
Additional Workforce Resourcing to support Model of Care Changes
▪ Additional resourcing for high volume SCOVID-low risk wards & COVID mx wards
Direct Care Nursing
▪ Dedicated resourcing for high volume SCOVID-low risk wards and COVID management wards
▪ Roving teams for low-volume SCOVID-low risk wards
PPE / Clinical Coach
▪ Maintained for COVID Management wards
Concierge
▪ Allocated to wards based on SCOVID-low risk, SCOVID-probable and COVID positive demand
RUSON
▪ Reallocation of existing additional resources from admissions wards to areas of high SCOVID-low risk demand
Support Services
14
Equipment Update
Equipment needs have been identified by ward areas in response to proposed changes to MOC
Priority items include:
▪ Vital Signs Machines
▪ Pulse Oximeters
▪ Commodes
▪ Linen Skips
▪ Pedal-operated Rubbish Bins
▪ PPE Trolleys
Commencement of delivery to sites (timing TBC)
Surplus equipment from JMPH to be distributed to high demand areas at MMC Clayton site
Planning underway to operationalize a Central Store at each site to provide access to essential
equipment based on demand
EMR ChangesJane Ross
16
An EMR one-stop-shop COVID Dashboard has been created to view COVID status and
simplify COVID-related actions…
The COVID Dashboard is visible to all clinical professions inclusive of Nurses, Midwives, Medical,
Allied-Health and Pharmacy
Incorporates and simplifies the management of COVID alerts, Isolation status and Documentation
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COVID Dashboard
1727/10/2020
Quick links to make
updates
Cross - requires actions
to clear the patient.
Tick – documentation
completed.
Cross - requires actions
to clear the patient.
Tick – documentation
completed.
PPE ChangesRhonda Stuart
19
% Positive Presentations vs COVID Presentations to Monash Health
20
Monash Health HCW COVID-19 Acquisition
Ward No. Staff Comments
Casey (COVID) Ward C 3 *Deteriorating patient / MET call
P block 7 Staff room, staff contact
HITH / community 2 Unrecognized positive family/PPE breech
West 2 7 Unrecognized elderly patient(s)
West 3 (COVID) 5 MET call / Confused combative patient
Ward 32 (COVID) 5 Combative patient /unwell elderly patient
Ward 33 3 *Confused deteriorating patients
South 6 2 ? Unrecognized elderly patient
We have had no transmission to
HCWs from any patients waiting for a
result through the first and second
waves with a total of >5,000 patients
going through that stream.
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PPE Compulsory Standards
22
PPE Compulsory Standards
23
PPE Changes Summary
▪ PPE changes to align with DHHS recommendations
▪ Takes into account lessons learned in 1st and 2nd waves
▪ Tier 1 = Non-COVID, not awaiting test results patients
▪ Tier 2 = Patients with pending COVID results (sCOVID) – low risk
▪ Tier 3 = All COVID positive patients, probable COVID PLUS patients with pending results
who have AGPs or AGBs
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Model of Care Revisions Summary
Status Details
Admission / Management Wards Updated
Cease Admission Wards, SCOVID-low risk
patients admitted to home wards direct from ED
COVID Management wards for confirmed
POSITIVE and SCOVID-Probable cases at each
site
ED / ICU Wards No change
Personal Protective Equipment (PPE) UpdatedUpdates as per DHHS PPE Guidelines – timing
aligned with MOC implementation (28 October)
PPE / Clinical Coach UpdatedIndividualised resourcing dependent on SCOVID-
low risk / probable admission demand
MET Call / Code Blue No changeFollow procedures in the updated flowcharts
published on 29 September
Pre-operative screening No change Maintain current pre-operative screening
DANDENONG HOSPITAL – Proposed Future StateWEST
Children’s
North 3
Maternity
SW4
ICU
SW2
SW3
West 2
W3
W4W4
Birth Suite
ED
DTC
AAU
CCU
Therapy
WRC
Theatre / Recovery
Outpatients
SOUTHWEST
CENTRE NORTH
Cafeteria Plant
General Medicine(Incl monitoring)
General MedicineEndocrinology
OrthopaedicsGeneral SurgeryVascular Surgery
Diabetes
General MedicineGeneral Medicine
Mixed Specialty General Medicine
Cardiology Mixed SpecialtyColorectal SurgeryGastroenterology
Obstetrics
SCN
Paediatric SurgeryPaediatric Medicine
Total Capacity: 4
Mental Health
Total Capacity: 36 Total Capacity: 36
Total Capacity: 36 Total Capacity: 36 Total Capacity: 17 Total Capacity: 28
Total Capacity: 70
Total Capacity: 30 Total Capacity: 20
Total Capacity: 24 Total Capacity: 14
Total Capacity: 25 Total Capacity: 20 Total Capacity: 20
Total Capacity: 8
Mental Health
Total Capacity:12 beds7 chairs
Discharge Lounge
North WardENT / Gynaecology
OMF / Plastic SurgeryOphthalmology
Unit 1Unit 2Unit 3
Total Capacity: 9
MATERNITY & NEWBORN PRECINCT
Non-COVID ICU
Total Capacity: 14
COVID ICU
Total Capacity: 22
Total Capacity: 25 Total Capacity: 8
Total Capacity: 9
COVID Mx
Pharmacy
AH Space
10 treatment spaces
ED Fast Track
COVID Mx
CASEY HOSPITAL – Proposed Future State
Ward H
Admin
THEA
TRE
Ward F Ward G SCN
Ward DSecure Ward D Ward C Ward B Ward A ED Ward E
OU
TPA
TIEN
TS
Paediatric MedicalPaediatric Surgical Obstetrics
Birth SuiteNeonatology
Mental Health
Total Capacity: 5
ObstetricsShort Stay
Unit
10 beds
Mental Health
25 beds
Sub-Acute
Breast / ColorectalEndocrine / ENT
Plastics / GeneralNeuroSx / Urology Gynaecology
IPU L4
IPU L5
ICU Day Ward
IPU L2
IPU L3
Total Capacity 32
Total Capacity 20Total Capacity 12
Total Capacity 32
Total Capacity 32
Vacant Mixed Surgical Specialties &
Gastroenterology
Vacant
Ward ADay Area
IMA
GIN
GTotal Capacity: 20 Total Capacity: 21 Total Capacity: 21
Total Capacity: 30 Total Capacity: 27 Total Capacity: 32 Total Capacity: 22 Total Capacity: 32
General Medicine
Palliative Care
General Medicine
Ward DGym
Dialysis
DialysisAnnex
ED
FastTrack
5 rooms
CHILDREN’S, MATERNITY & NEWBORN PRECINCT
Total Capacity: 20 Total Capacity: 21 Total Capacity: 21
Total Capacity: 22 Total Capacity: 12
Mixed ICU
HITH
9 chairs9 chairs
Cubicles
General Medicine
Vacant
Total Capacity 32
COVID Mx
General Medicine
COVID Mx
DTC
Corporate
SCN / NICU
Site Administration
IPU
3A FORREST
TherapySCC
Outpatients
Cafe
ED SSU
CCU
ICU
ED
L5
L4
L3
L2
32W
Ward 41
General Medicine General Medicine
Ward 42
Ward 33 Ward 34Nephrology
Gastroenterology
Ward 44Haematology / Infectious Diseases
Dermatology / EndocrinologyRheumatology / Oncology
MonashHeart / CardiologyCardiothoracic Surgery
Respiratory
Ward 32
Ward 54Neurology
NeurosurgeryStroke
Ward 52
Total Capacity: 40 Total Capacity: 41
Total Capacity: 46
Total Capacity: 52
Total Capacity: 46
Total Capacity: 40
Total Capacity: 48
Total Capacity: 48
P Block Cath Lab
Obstetrics
Cardiac Day Treatment
Centre
TC: 13
General Surgery / Upper GI Surgery / Vascular SurgeryEndocrine Surgery / Gynaecology / Urology
ENT Surgery / OMF Surgery / Gastroenterology
MONASH MEDICAL CENTRE CLAYTON ADULT CAMPUS – PROPOSED FUTURE STATE
Endoscopy Plant PlantPlantL1
Monash Heart / Cardiology
TC: 23
TC: 15
Recovery / Theatre
Sleep Centre
31S 31N
LIN
KW
AY
LIN
KW
AY
3B PICUAll Specialties
TC: 10 (7)
Paed MedicinePaed Surgery
Non-COVID ICU
TC: 34
ObstetricsSCN
Total Capacity:
19 + 6 SCN
51NSurgery
Total Capacity:
23
51S
Total Capacity: 67 + 6 SCN
MATERNITY ZONE
Obstetrics
HITH
Hospital in the Home
Imaging
Immediate Care Centre Imaging Day Ward
Total Capacity: 12
ED Fast TrackClinic A / B
Respiratory
TC: 4TC: 20
TC: 34 TC: 26
Mixed ICU
Adult Mental Health
Total Capacity: 31
COVID MANAGEMENT
COVID MANAGEMENT
Cardiothoracic SurgeryNeurosurgery
Contracted Care
Total Capacity: 52
Plant
TherapyCafe
MaternityPrecinct
Birth SuiteFoetal
MonitoringPAU
ED SSUIPU
Adult CCUIPU
TheatresAdult ICU
IPU
ED
L5
L4
L3
L2
4A CanopyPaed Haematology / Oncology
Paed Respiratory / Paed IDPaed Monash Heart / CardiologyPaed Endocrinology and Diabetes
Paed General Medicine
4B Aviary
Same Day Unit
4E Sleep Centre
Paed Sleep Study
PICU
3B Cocoon - PICU
Total Capacity: 32 Total Capacity: 6
Total Capacity: 208 (SD) + 4 Haemodialysis
Total Capacity: 10
Specialist Clinics
L1
3A Forrest
Site Administration
3D Lagoon
Theatre / Recovery
Nest – SCN / NICU
SCN - Newborn NICU - Newborn
Total Capacity: 56 cots
Theatre / Recovery
Stepping Stones
4E Neurodiagnostic / Research
Total Capacity: 6
Vacant
Opportunity:Capacity: 10
Ambulatory CentreInfusion Centre and MC@H
Capacity: 8
Plant
AdultCampus
Lin
kway
Lin
kway
Therapy
Opportunity:3 beds
GymPlayroom
3 beds
Playroom
3 beds
MONASH CHILDREN’S HOSPITAL – CLAYTON – PROPOSED FUTURE STATE
Lin
kway
NEWBORN ZONE
Total Capacity: 66 cots + 5 parent rooms
Total Capacity:
12
Total Capacity:
4
Total Capacity:
16
Total Capacity: 9
4C Children’s Cancer Centre
Total Capacity: 22
Stage One Recovery
Stage Two Recovery
3C Cove
TheatreRecovery
TheatreRecovery
Total Capacity: 8
Oncology
Bereavement Space
3 beds
Oasis
Total Capacity: 20 Total Capacity: 8
Mental Health Mental Health
Paed Endocrinology and DiabetesPaed Gastroenterology / Paed ENT
Paed General MedicinePaed Nephrology and Continence
Paed RespiratoryPaediatric Surgery
Total Capacity: 34
Adolescent MedicinePaed General Medicine
Paed NeurologyPaed Rehabilitation
Total Capacity: 32
COVID MANAGEMENT
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Questions
