Hospital Command Center THIS DOCUMENT IS SUBJECT TO CHANGE, BASED ON NEW GUIDANCE FROM THE HOSPITAL COMMAND CENTER AND PUBLIC HEALTH AGENCIES (SCC PHD, CDC, CDPH) AND REMAINS IN EFFECT FOR THE DURATION OF THE COVID-19 PANDEMIC PUBLIC HEALTH EMERGENCY TITLE: Communication of Positive SARS CoV-2 Test Result, Standardized Procedure Who May Perform This Procedure RN X* MUC LVN HSR HSA Techs MA MD Other (specify) *Any RN (contract or otherwise) working with an internal or external team responsible for testing and resulting of COVID-19. PURPOSE: To outline the registered nursing responsibilities in communicating positive SARS CoV-2 test results. LEVEL: Independent. This standardized procedure may be initiated by Registered Nurses (RN) without a physician order. SUPPORTATIVE DATA: This standardized procedure complies with the California Board of Registered Nursing (BRN) Standardized Procedure Guideline, and may be performed by RNs, who have been authorized through evaluation and approved in writing to perform/initiate this standardized procedure. No direct supervision of the RN is required. Location (includes hospital and all inpatient and outpatient locations and subacute facilities of the hospital, unless otherwise indicated) Enterprise Wide X O’Connor Hospital Santa Clara Valley Medical Center St. Louise Regional Hospital
Transcript
Hospital Command Center
THIS DOCUMENT IS SUBJECT TO CHANGE, BASED ON NEW GUIDANCE FROM THE HOSPITAL COMMAND CENTER AND PUBLIC HEALTH AGENCIES (SCC PHD, CDC, CDPH) AND REMAINS IN EFFECT FOR THE DURATION OF THE COVID-19 PANDEMIC PUBLIC HEALTH EMERGENCY TITLE: Communication of Positive SARS CoV-2 Test Result, Standardized
Procedure
Who May Perform This Procedure RN X* MUC LVN HSR HSA Techs MA MD Other (specify)
*Any RN (contract or otherwise) working with an internal or external team responsible for testing and resulting of COVID-19. PURPOSE: To outline the registered nursing responsibilities in communicating positive
SARS CoV-2 test results.
LEVEL: Independent. This standardized procedure may be initiated by Registered Nurses (RN) without a physician order.
SUPPORTATIVE DATA:
This standardized procedure complies with the California Board of Registered Nursing (BRN) Standardized Procedure Guideline, and may be performed by RNs, who have been authorized through evaluation and approved in writing to perform/initiate this standardized procedure. No direct supervision of the RN is required.
Location (includes hospital and all inpatient and outpatient locations and subacute facilities of the hospital, unless otherwise indicated) Enterprise Wide X O’Connor Hospital Santa Clara Valley Medical Center
St. Louise Regional Hospital
Hospital Command Center
I. CONTENT A. REQUIRED PATIENT CONDITIONS:
1. Patient obtained a SARS CoV-2 test at an outpatient site operated by Santa Clara Valley Medical Center AND has a positive SARS CoV-2 test result.
B. ASSESSMENT AND PLAN (see Appendix A for workflow):
1. Individual will be contacted by phone. Written communication regarding the positive result (Appendix C) will be sent to the individual after the first missed phone call attempt. Continue making additional follow up calls after the communication is sent until you are able to reach the individual.
2. Verify individual using two (2) identifiers. 3. Verify SARS CoV-2 test is resulted in the electronic health record (EHR)
/ or other designated location. Review the EHR to check for any prior SARS CoV-2 results and note the dates.
4. Provide SARS CoV-2 test result to individual/parent/guardian.
C. EDUCATION:
1. Instruct individual to follow up with his/her primary care provider as soon as possible for follow up and additional guidance. Public Health Department contact tracers and team calling positive results will be reaching out to the individual with more information. If the individual does not have a primary care provider, refer to Valley Connection at: 1 (888) 334-1000. If this was a repeat test after a prior positive test within the past 90 days and the patient has no symptoms, provide them with SCC PHD “COVID-19 Work/School Letter” and advise the individual that this test result does not change their initial isolation period and that we do not recommend repeat testing within the 90 days window after a positive test because there is conferred short term immunity. See Appendix B.
If this is the individual’s initial positive test, provide the isolation instructions below. If the individual previously had a positive result and was re-tested, advise that re-testing until getting a negative
Hospital Command Center
result is not recommended. Advise that the repeat positive result does not change the prior guidance for isolation duration.
a. Advise individual to isolate at home until able to discuss follow up with the primary care provider. This includes self-isolation from household members.
b. Stay home except to get medical care. • Do not go to work, school, or public areas. • Avoid using public transportation, ridesharing, or taxis. • Wear a face mask at all times except for when you are alone or eating
or drinking. Do not interact with others without wearing a facemask. c. Separate yourself as much as possible (minimum of 6 feet) from other
people and animals in your home. • People: As much as possible, you should stay in a specific room and
away from other people in your home. Also, you should use a separate bathroom, if available.
• Animals: You should restrict contact with pets and other animals while you are sick, just like you would around other people.
d. Wear a mask when you are in your house around others.
e. Call ahead before visiting your doctor and inform your doctor of your
positive COVID test result. Always wear a mask if you leave your house to get medical care.
f. Cover your coughs and sneezes with a tissue or use the inside of your elbow.
g. Clean your hands often with soap and water or hand sanitizer for at least 20 seconds.
h. Avoid sharing personal household items like dishes, cups, utensils, towels, or bedding.
i. Clean all “high-touch” surfaces such as phones, doorknobs, keyboards tv remotes, etc. every day.
j. If close contacts become sick, they should contact their healthcare provider to determine if testing is needed. They should call their provider before they go in and wear a mask if available.
k. Instruct individual to call 911 or to go to the Emergency Department if he/she is experiencing a medical emergency such as trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, bluish lips or face.
l. If the individual sounds confused or disoriented on the phone that may indicate a potential medical or psychiatric emergency, call 911 and advise the individual that you are doing so.
Hospital Command Center
For COVID-19 quarantine support, the patient may call the referral hotline at 1 (408) 808-7770. The referral hotline is available 7 days/week, 8 am – 5 pm.
m. For additional COVID-19 information regarding isolation and quarantine, etc. refer individual to the Santa Clara County Public Health website at: https://www.sccgov.org/sites/covid19/Pages/home.aspx and/or the CDC website at: https://www.cdc.gov/coronavirus/2019-ncov/index.html
2. Send a copy of the test result to the individual via mail or e-mail.
D. PROVIDER NOTIFICATION:
1. Consult with designated provider if individual has specific questions
regarding isolation/quarantine that need additional clarification. See Appendix A.
E. DOCUMENTATION:
1. Documentation of the following communication elements will occur in the electronic platform where the positive result is stored.
a. EPIC/Healthlink: i. Two (2) patient identifier, confirmation of parent/guardian. j. SARS CoV-2 test result provided to patient/parent. ii. Instructions provided. iii. Any provider notifications, reason for notification, and any
follow up / interventions. iv. Use of language assistance per policy, as applicable.
b. Contract Lab(s)
i. Follow the contract lab(s)’ processes which may include a simple check box that patient/parent was notified of test result.
F. REQUIREMENTS OF RN:
1. EDUCATION/TRAINING: In-service/orientation and competency validation to the standardized procedure.
2. EXPERIENCE: Minimum or completion of in-service/orientation in a clinical setting.
Completion of in-service /orientation/competency validation to the standardized procedure. Competency validation for performing this standardized procedure will be documented and maintained in the learning management system or in paper form.
4. ON-GOING EVALUATION:
Annual review of competency.
G. DEVELOPMENT & APPROVAL OF THE STANDARDIZED PROCEDURE:
1. METHOD: Developed and approved by authorized representatives of Administration, Medical Staff, and Ambulatory Care Nursing.
2. REVIEW: Annual REFERENCES: 1. Santa Clara County Public Health, Home Isolation & Quarantine Guidelines, Rev.
7. Centers for Medicare and Medicaid Services (CMS) State Operations Manual
Appendix A for Hospitals, Regulations and Interpretive Guidelines for Hospitals, §482.24(c)(3). Retrieved 7/24/18 from: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R170SOMA.pdf
APPENDICES: Appendix A: Nursing Workflows, Results Management Appendix B: COVID-19 Work / School Letter, Santa Clara County Public Health Appendix C: COVID-19 Test Result E-Mail Script Approved: HOSPITAL COMMAND CENTER APPROVED: October 2, 2020
Communication of Positive SARS CoV-2 Test Result, Standardized Procedure
Appendix A: Nursing Workflows—Result Management
1 Appendix A Nursing Workflows- Valley Connection_092220
Workflow HealthLink Fulgent/Healthvana
Calling Patients with Positive Results—for those who live in Santa Clara County
1. Check in-basket pool for results 2. Confirm the patient’s home address is in Santa
Clara County 3. Confirm if patient is pediatric or adult; if
pediatric, check for parent contact 4. Check preferred language. If other than English
and an interpreter is needed, call 408-808-6150 for an interpreter to make a call.
5. Call phone number listed in demographics 6. Introduce yourself, Ask for patient (or parent if
pediatric patient) 7. Confirm Date of Birth 8. Ask if they have already been notified about
their COVID test result 9. Inform them the result is positive; ask if this is
their first positive result 10. If first positive result, then advise if you live in
Santa Clara County, the Public Health Department will provide guidance on isolation duration but if you live in another county please contact your local Health Department or your physician.
11. Inform them that the call will come from the “CA COVID Team” caller ID. Advise on home isolation precautions. Advise them to contact their MD for more guidance.
12. If no physician, route patient to Valley Connection HSR for registration. If uninsured, telephone appointment is scheduled with VC physician or Urgent Care. If patient is paneled to our system, telephone appointment with PCP if available within 24 hours or with VC physician or Urgent Care.
1. Check Healthvana for new positives; prioritize calls to those who have not reviewed their result yet
2. Confirm the patient’s home address is in Santa Clara County
3. Confirm if patient is pediatric or adult; if pediatric, check for parent contact
4. Call phone number listed in Healthvana 5. Introduce yourself, Ask for patient (or
parent if pediatric patient) 6. If language is other than English and an
interpreter is needed, tell the patient you will call back. Call 408-808-6150 for an interpreter to make a call.
7. Ask if they have already received a call about their COVID test result—in most cases the answer will be yes, by the Public Health team
8. If they have not yet been called, confirm DOB and provide result. Ask if this is the first positive test they have had.
9. If first positive result, then advise if you live in Santa Clara County, the Public Health Department will provide guidance on isolation duration but if you live in another county please contact your local Health Department or your physician.
10. Advise them to contact their MD for more guidance.
11. If they previously had a positive result and were re-testing, advise that re-testing until getting a negative result is not recommended. The repeat positive result
Communication of Positive SARS CoV-2 Test Result, Standardized Procedure
Appendix A: Nursing Workflows—Result Management
2 Appendix A Nursing Workflows- Valley Connection_092220
Workflow HealthLink Fulgent/Healthvana
13. If they previously had a positive result and were re-testing, advise that re-testing until getting a negative result is not recommended. The repeat positive result does not change the prior guidance for isolation duration.
14. Provide document from Public Health via e-mail. 15. Ask if they need documentation of their positive
result (see below) 16. Document call in HealthLInk and fax letter to the
PHD. 17. Remove result from in-basket pool by clicking
“done”
does not change the prior guidance for isolation duration. Provide document from Public Health via email.
12. Ask if they need documentation of their positive result
Calling Patients with Positive Results—for those who live outside of Santa Clara County
1. Check in-basket pool for results 2. Confirm the patient’s home address is NOT in
Santa Clara County 3. Confirm if patient is pediatric or adult; if
pediatric, check for parent contact 4. Call phone number listed in demographics 5. Introduce yourself, Ask for patient (or parent if
pediatric patient) 6. Confirm Date of Birth 7. Ask if they have already been notified about
their COVID test result 8. Inform them the result is positive; ask if this is
their first positive result 9. If first positive result, then advise them that they
need to call their physician for further guidance, but you can provide initial guidance. If they don’t have a physician, advise them to contact their local Public Health Department for guidance. Advise them that most people need isolation for 10 days after a positive test. Advise on home isolation precautions.
1. Check Healthvana for new positives; prioritize calls to those who haven’t reviewed their result yet
2. Confirm the patient’s home address is NOT in Santa Clara County
3. Confirm if patient is pediatric or adult; if pediatric, check for parent contact
4. Call phone number listed in Healthvana 5. Introduce yourself, Ask for patient (or parent if
pediatric patient) 6. Ask if they have already received a call about
their COVID test result—since they are out of county, they might not have been contacted by anyone yet
7. If they have not yet been called, confirm DOB and provide result. Ask if this is the first positive test they have had
8. If first positive result, then advise them that they need to call their physician for further guidance, but you can provide initial guidance. If they don’t have a physician, advise them to
Communication of Positive SARS CoV-2 Test Result, Standardized Procedure
Appendix A: Nursing Workflows—Result Management
3 Appendix A Nursing Workflows- Valley Connection_092220
Workflow HealthLink Fulgent/Healthvana
10. If they previously had a positive result and were re-testing, advise that re-testing until getting a negative result is not recommended. The repeat positive result does not change the prior guidance for isolation duration.
11. Consider, is patient visiting from another Country or State. If the patient does not have a physician, patient can go to any urgent care of their choice.
12. Ask if they need documentation of their positive result (see below)
13. Provide document from Public Health via e-mail. 14. Document call in HealthLInk
contact their local Public Health Department for guidance. Advise them that most people need isolation for 10 days after a positive test. Advise on home isolation precautions. Advise them to contact their MD for more guidance.
9. If they previously had a positive result and were re-testing, advise that re-testing until getting a negative result is not recommended. The repeat positive result does not change the prior guidance for isolation duration.
10. Ask if they need documentation of their positive result
Sending email documentation of positive result
Once the patient has been called re the positive result, the result will be released to send out via email. If the patient is unable to be contacted, the result will be released within 24 hours anyway to ensure patient receives the result.
1. Ask if the person received a text message or email from HealthVana. If so, ask if they are able to view/print the result from that (assure them this is a legitimate site—the one we use to communicate results)
2. If they don’t use technology and need the result delivered another way, ask if the result may be sent via email or if it needs to be sent over mail
3. If the result needs to be sent via mail, escalate 4. If the result needs to be sent over email,
confirm that the email in HealthVana is correct.
Responding to inquiries about negative results that weren’t received
1. Check list of testing locations to help determine if test will be in HealthLInk or HealthVana.
2. If HealthLink, check for result. 3. Check shared COVID 19 email address to see if
email was sent to the patient.
1. Check list of testing locations to help determine if test will be in HealthLInk or HealthVana
2. If HealthVana, check for result 3. Provide result from the applicable result
management portal.
Communication of Positive SARS CoV-2 Test Result, Standardized Procedure
Appendix A: Nursing Workflows—Result Management
4 Appendix A Nursing Workflows- Valley Connection_092220
Workflow HealthLink Fulgent/Healthvana
a. Was an email sent to the patient? If email addresses match, but patient did not receive, RN can verbally inform the patient of the negative test result, re-send the email, and document as a telephone encounter, utilizing the .Covid19RnNegativeResult dot phrase.
b. If unable to find email address from the shared email address, send message to the VC HSR Pool for follow up.
c. If the email address is incorrect, send correct email to the VC HSR Pool for follow up.
Managing bounced back results 1. Receive a file daily from Nancy/Karin/Hoang of emails that bounced back and will be sent by mail
2. Call each patient to inform them that their result is negative but coming via mail since their email bounced back
3. If any urgent need to provide via email, document corrected email and send to Nancy/Karin/Hoang
Not applicable since results are sent to either phone number by text or email—Healthvana will manage
Scheduling Test Appointment
HealthLink Fulgent
Ask the patient if they have a PCP in our system. If no, proceed with Fulgent scheduling. If yes, ask if they are feeling sick. If no, proceed with Fulgent scheduling. If
Not applicable 1. Ask the patient if they have access to a computer and email and are able to schedule online. If so, advise them to go to sccfreetest.org and click on “Schedule an appointment” at the top of the page
Communication of Positive SARS CoV-2 Test Result, Standardized Procedure
Appendix A: Nursing Workflows—Result Management
5 Appendix A Nursing Workflows- Valley Connection_092220
HealthLink Fulgent
system PCP and has symptoms, proceed to workflow below
2. If they aren’t able to schedule online, ask if they would like to schedule over the phone. Inform them the process to schedule will take about 15 minutes
3. Go to the Fulgent Scheduling website and read the questions to the patient, entering their answers
4. At the point of entering an email address, enter the team’s shared Outlook address
5. Go tot eh shared email inbox and find the email to schedule a Fulgent appt; complete the scheduling process by asking the patient the remaining questions
6. Read the consent form to the patient from the Fulgent website
7. Offer dates and times from the Fulgent site 8. Go to the Fulgent admin portal and search for
the patient by name, find their appointment and click on “Edit” to update their email address. Remove the email address if they don’t have email
9. Go to the shared email inbox and find the confirmed appt email. Forward it to the patient if they have email
10. Inform the patient to call the Result Management Line 4 days after their test to receive a result (since HealthVana probably won’t be a workable option for them)
Patient has a system PCP and patient is feeling sick
Proceed with current process.
Communication of Positive SARS CoV-2 Test Result, Standardized Procedure
Appendix B: COVID-19 Work / School Letter, Santa Clara County Public Health
SVCHTradSimp-Appendix C Test Result EMail Script phn 09-25-20 - Translated by VMC LS (RM, LT, VC) 09/20
Communication of Positive SARS CoV-2 Test Result, Standardized Procedure
Appendix C: COVID-19 Test Result E-Mail Script
Dear XXXX, We left a voicemail for you earlier today but were unable to reach you. Attached please find the result of your COVID-19 test. The test was positive, meaning that you have COVID-19 infection. You will need to stay home and isolate yourself from others. The Public Health Department will be contacting you soon if it has not done so already. Please note that our phone numbers may come up as a blocked or unknown number on your phone. We recommend that you answer these calls and check your voicemail frequently so as not to miss important follow up. Please also contact your physician for further guidance. We will try to call back again later today. Best regards, COVID-19 Test Result Support Team Santa Clara Valley Medical Center Spanish Estimado/a XXXX: Hoy le dejamos un mensaje de voz, pero no pudimos comunicarnos con usted. Adjunto encontrará el resultado de su prueba de COVID-19. La prueba resultó positiva, lo que significa que usted tiene una infección por COVID-19. Deberá quedarse en casa y aislarse de los demás. El Departamento de Salud Pública pronto se comunicará con usted si aún no lo ha hecho. Tome en cuenta que nuestros números de teléfono pueden aparecer en su identificador de llamadas como un número bloqueado o desconocido. Por eso le recomendamos que conteste esas llamadas y también revise sus mensajes de voz con frecuencia para no perderse de un aviso importante. Además, comuníquese con su médico para obtener más orientación. Intentaremos volver a llamarle más tarde el día de hoy. Atentamente, Equipo de Apoyo para Resultados de Prueba COVID-19
SVCHTradSimp-Appendix C Test Result EMail Script phn 09-25-20 - Translated by VMC LS (RM, LT, VC) 09/20
Santa Clara Valley Medical Center Traditional Chinese
致 XXXX 先生/女士，
我們今天早些時候為您留下了語音信箱，但無法聯繫到您。请於附件中查看
您的 COVID-19 測試结果。測試為陽性，表示您感染了 COVID-19。 您將需
要待在家裡與他人隔離。 公共衛生部門將盡快與您聯繫如果您尚未被通知
到。 請注意，我們的電話號碼可能會在您的來電號碼上顯示為被阻止
(blocked) 或未知 (unknown)。我們建議您接聽這些電話，並經常地檢查您的
語音信箱，以免錯過重要的後續活動。另請聯繫您的醫生以獲取進一步指
導。
我們將會嘗試在今天晚些時候再次致電。
致上我們最高的問候，
COVID-19 測試結果支持團隊
聖塔克拉拉縣 Valley 醫療中心 (SCCVMC)
Simplified Chinese
致 XXXX 先生/女士，
我们今天早些时候为您留下了语音信箱，但无法联系到您。请于附件中查看
您的 COVID-19 测试结果。测试为阳性，表示您感染了 COVID-19。您将需
要待在家里与他人隔离。 公共卫生部门将尽快与您联系如果您尚未被通知
到。请注意，我们的电话号码可能会在您的来电号码上显示为被阻止
(blocked)或未知 (unknown)。我们建议您接听这些电话，并经常地检查您的
语音信箱，以免错过重要的后续活动。另请联系您的医生以获取进一步指
导。
我们将会尝试在今天晚些时候再次致电。
致上我们最高的问候，
COVID-19 测试结果支持团队
SVCHTradSimp-Appendix C Test Result EMail Script phn 09-25-20 - Translated by VMC LS (RM, LT, VC) 09/20
圣塔克拉拉县 Valley 医疗中心 (SCCVMC)
Vietnamese Kính gởi Chúng tôi đã nhắn tin lại trong điện thoại của quý vị ngày hôm nay, và cũng không thể liên lạc trực tiếp với quý vị. Kết quả xét nghiệm COVID-19 của quý vị có đính kèm trong thư này. Kết quả là dương tính, có nghĩa là quý vị bị nhiễm COVID-19. Quý vị cần phải ở yên trong nhà và cách ly những người khác. Sở Y Tế Công Cộng sẽ sớm liên lạc quý vị nếu chưa liên lạc quý vị trong thời gian qua. Xin lưu ý số điện thoại của chúng tôi sẽ hiện lên là số bị ngăn chận hoặc số lạ. Quý vị nhớ trả lời điện thoại từ các số điện thoại của người lạ, và kiểm tra tin nhắn thường xuyên để có thể nghe được thông tin quan trọng về kết quả xét nghiệm. Quý vị cũng cần liên lạc với bác sĩ của quý vị để được hướng dẫn thêm. Chúng tôi sẽ cố gắng gọi trở lại quý vị ngày hôm nay. Kính chào quý vị, Nhóm Thông Báo Kết Quả Xét Nghiệm COVID-19 Santa Clara Valley Medical Center .
