Post-Discharge Provider Playbook

Transcription

1 Post-Discharge Provider Playbook 1

2 Contents Playbook Contributors... 3 Discharge Planning... 4 Extended Care Options... 4 Skilled Nursing Facilities (SNF)... 4 Outpatient Rehab... 4 Home Health... 4 Respiratory Clinics... 5 Patient Discharge Instructions... 5 Behavioral Health Considerations and Resources Telemedicine Home Monitoring (e.g., AMITA Check) Specialty Considerations Cardiology Hematology / Oncology OBGYN Neonate Pediatrics Dermatology Ophthalmology Testing and Convalescent Plasma Testing Convalescent Plasma Mass Mailing Distribution Appendix [Press ctrl+ click on section header to jump to relevant section] 2

3 Playbook Contributors Pulmonary - Dr. Edward Diamond Primary Care - Dr. Mark Collins Primary Care - Dr. Maninder Kohli Lab Testing and Plasma - Dr. Janis Atkinson Cardiology - Dr. Daniel Sauri Infectious Disease - Dr. Ivette Murphy-Aguilu Post-Acute - Dr. Tim McCurry Hematology / Oncology - Dr. Kelley Kozma Hematology / Oncology - Dr. Jay Dalal Neonatal - Dr. Joyce Gemson Pediatrics - Dr. Nour Akhras Hospitalist - Dr. Sunil Varma Behavioral Health - Dr. Clif Saper CIN / ACO / Medical Group - Don Franke Medical Group - Dr. Reinhold Llerena CIN / ACO Operations - Ann Marie Gaber-Niemer Case Management - Ron Austin Home Health - Kathleen Gunderson Social Determinants of Health - Aleta Rupert Rehab - John Dunkin Health Equity - Pam Mitchell-Boyd Telehealth - Laura Dunlap-Messineo Pharmacy - Sylvia Chen Pharmacy - Sun Lee-Such Pharmacy - Andrius Cepenas Pulmonary / Critical Care - Kim French Patricia Mencia Please contact Edward.Diamond@amitahealth.org with questions 3

4 Discharge Planning 1. Evaluation of Skilled Nursing Facility (SNF), Inpatient Rehab Facility (IRF), palliative care, and Home Health qualification (homebound). Also consider House Calls physicians (Home Visits) who can follow patient in home safely. Complex patient going home with no identified PCP can be followed by Comprehensive Care Clinic (C3). 2. Consider safe discharge (e.g., ability to self-isolate if still considered Positive) Repeat testing is not the preferred method (limited testing resources and positive tests don t always mean persistent active infection) Prefer symptom-based criteria (10 days from positive test, 3 days without fever off antipyretics, and improving symptoms) 3. Identify PCP and coordinate follow-up appointment Contact the PCP & Pulmonary offices; request appointments; preferably Telehealth initially Record the date and time of the appointments in the chart Notify PCP of need for Transition Visit and need for Pulmonary follow-up post discharge 4. RN to print discharge instructions (next section) and provide to patient at discharge 5. Patients hospitalized for COVID-19 illness require regular, close follow up post discharge until all symptoms, laboratory and radiographic abnormalities have resolved. Extended Care Options An unresolved challenge is the lack of availability of post-discharge extended care and Rehabilitation facilities for the COVID-19 population. Community partnerships required. Skilled Nursing Facilities (SNF): In most SNFs, both primary care and pulmonary round on these patients. SNFs are designed to deliver services that cannot safely be provided at home. Services rendered include but are not limited to intravenous administration of medication, physical therapy, occupational therapy, respiratory therapy and extensive wound care. Care is provided on a short-term basis, typically less than 30 days. Some SNFs have dedicated COVID units and are prepared to safely care for affected patients. To determine if SNF placement is appropriate and to locate SNFs with COVID units, please contact the hospital s Case Management department. Outpatient Rehab: AMITA Outpatient Rehabilitation available to see recovering COVID+ patients. The outpatient rehabilitation clinics at Alexian Brothers, St. Alexius, PSJH-E, Mercy Medical Center, Woodridge and Bartlett have already begun seeing COVID recovery patients and have patient care guidelines in place. This includes the Day Rehab Program in Elk Grove Village. Home Health COVID positive patients have been designated by CMS as homebound due to the need to isolate. The other qualifying need is for skilled services, RN, PT, OT, or ST. Most of the home health COVID positive patients currently on service with AMITA Home Health have medication management 4

5 and education needs as a follow up to pneumonia. Care will usually include oxygen monitoring via pulse oximetry, rehab for deconditioning, and proper use of a nebulizer if applicable. A specific care path for COVID positive patients has not been developed, but could include any detailed recommendations from RT as appropriate. Palliative Care: Supports the physical, psychosocial, and spiritual needs of those with serious or chronic illness. Respiratory Clinics: The Respiratory Clinics are intended to treat patients prior to a COVID-19 diagnosis or hospitalization. Post-hospitalized patients should be seen by their PCP and/or pulmonary specialist rather than at the Respiratory Clinics. The Respiratory Clinics plan to remain open and offer ongoing COVID-19 symptomatic evaluation for as long as needed. Patient Discharge Instructions The following has been adapted from UVA Health Coronavirus (COVID-19) Discharge Instructions. COVID- 19 Discharge templates also exist within the various EMR platforms at AMITA Health and can be supplemented with patient specific information such as symptomology, lab work, medications upon discharge, and course of action. You were diagnosed with the novel Coronavirus, known as COVID-19. It is a viral illness that can cause fever, cough and trouble breathing. Some people may have chills, muscle aches, runny nose, sneezing, sore throat, upset stomach or loose stool. Upon discharge from AMITA, you will be asked to wear a mask. You should wear it until you get home. When do I need to call the doctor? Call your doctor if your breathing is getting worse (harder or faster than before or you feel like you are getting less air). Some people start to feel worse in the second week of their illness, if you start to feel worse at any time in your illness, please call your doctor, who will tell you where to go to be seen. If you can, put on a facemask before leaving home or before you enter the clinic or hospital. Call or go to the Emergency Room right away if you develop emergency warning signs of COVID- 19 such as: trouble breathing, chest pain or pressure that does not go away, new confusion or extreme fatigue (i.e., lethargy), bluish lips or face. Precautions at home 5

6 The virus is spread easily through tiny droplets when you cough or sneeze. You should take these steps to help prevent the disease from spreading to people in your home and community 1. Self-isolate at home As advised by the Centers for Disease Control and Prevention (CDC), we ask you to stay in your home and limit contact with others to avoid spreading this virus. Stay home except to go to the doctor Do not go to work, school, or public areas, except for getting medical care. Avoid using public transportation (such as buses), ridesharing, or taxis. If you have an upcoming doctor appointment, call the office and tell them that you have COVID-19. Separate yourself from other people and animals in your home. Avoid touching other people, including handshaking. As much as you can, stay in a specific room and away from other people in your home. o You should also use a separate bathroom, if available. o Avoid sharing personal household items. You should not share dishes, drinking glasses, cups, eating utensils, towels, toothpaste, or bedding with other people or pets in your home. After using these items, they should be washed well with soap and water. Do not handle pets or other animals while sick. 2. Clean and disinfect Clean all high-touch surfaces every day. High-touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Clean any surfaces that may have blood, stool, or body fluids on them. Use a household cleaning spray or wipe, according to the label instructions. o Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good air flow in the room during use of the product. Wash laundry. Remove and wash clothes or bedding that have blood, stool, or body fluids on them and then wash your hands right away 6

7 3. Help stop the spread Clean your hands often. Wash your hands with soap and water for at least 20 seconds. OR Use an alcohol-based hand sanitizer that contains at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Wash your hands after blowing your nose, coughing, or sneezing; going to the bathroom, and before eating or preparing food. Avoid touching your eyes, nose, and mouth with unwashed hands. Cover your coughs and sneezes. Cover your mouth and nose with a tissue when you cough or sneeze. Throw used tissues in a lined trash can; clean your hands right away. Wear a facemask You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) or pets and before you enter a healthcare provider s office. 4. Notify your close contacts People that you live with should self-isolate for 14 days AFTER your self-isolation period ends. Other close contacts such as caretakers and intimate partners should self-isolate for 14 days AFTER your last contact with them. Your close contacts should self-monitor for symptoms by checking their temperature twice a day and watching for fever, cough, or shortness of breath. They should contact their doctor if they develop symptoms of COVID-19. They should also clean hands often and avoid touching eyes, nose, and mouth with unwashed hands. They should wear a mask if they have to be in the same room as you if you are not able to wear one. When can I stop precautions at home? You can stop isolating yourself when all of these things have happened: 7

8 You have had no fever for at least 72 hours (that is three full days of no fever without the use of medicine that reduces fevers) AND Other symptoms have improved (for example, when your cough or shortness of breath have improved) AND At least 10 days have passed since your symptoms first started. Some patients that will need ongoing medical care may also need to have 2 negative tests before precautions are stopped. Your doctor will let you know if additional testing is needed. Managing your stress and anxiety You are a survivor in charge of your recovery. You re on your way home, to a rehab setting, or to residential care. Many patients discharging after recovering from COVID-19 have reported symptoms of anxiety, depression, fatigue, sleep difficulties, feeling on edge, difficulty paying attention, struggling to solve problems, organizing thoughts, and memory problems. All these symptoms are normal and to be expected, given the trauma you have experienced. They may last from a few weeks to several months. The virus emotionally affected not only you, but also your family members. If you or your family feel emotionally impacted, it is critical for you and your family to follow-up as soon as possible with a behavioral health provider. If an AMITA Health provider is unable to assist you, you will be connected to a resource outside the system so you can get the care you need. Professional Counseling Services Please find below a list of locations and phone numbers for scheduling an appointment. Aurora, Bartlett, Bolingbrook, Carol Stream, Des Plaines, Elgin, Elk Grove Village, Glendale Heights, Hinsdale, Hoffman Estates, Joliet, Lake Zurich, Palatine, and Westmont: Arlington Heights Bourbonnais Chicago AMITA Health St. Joseph Hospital: Chicago AMITA Health Saints Mary and Elizabeth Medical Center: Chicago AMITA Health Chicago, 1127 Oakley Blvd.: x8510 Evanston Melrose Park x8510; En Español

9 Westchester x5514 Additional No-cost Resources in the Chicago Area and Northwest Indiana N.A.M.I. help line (M-F 9 am- 8 pm; Sat and Sun 9 am-5 pm) Chicago Department of Public Heath Mental Health Centers (M-F 8:30 am-4:30 pm) In Northwest Indiana, contact the Rapid Assistance Line: and select 2, then 9 for mental health support After-hours support text: HOME to for a crisis counselor 24/7 National Suicide Prevention Hotline Community Resources AMITA Health understands that many factors contribute to your physical and emotional health. To help connect you to community resources and give you peace of mind, we have created an easy way to access the services you may need. You can search for programs in your area, including: Medical Needs Food Financial Assistance Housing/Utilities Assistance Employment Guidance Transportation To get started, visit AMITAhealth.org/patient-resources/community-resources. At AMITA Health, we are here for you, always. In sickness and in health. Once on the website it will prompt you to add your zip code to see a list of community resources in your area. For more information: CDC Coronavirus Website CDC Coronavirus Frequently asked question - ncov/faq.html Guideline for Schedule of Post Hospital Visits 9

10 As a guide that may be altered by clinical judgement of the PCP and team of specialists (pulmonary, cardiology, ID, Hem/Onc, Peds, OB/GYN, renal, behavioral health, etc.), consider follow-up visits either in person or by telemedicine. The pulmonary service will be available to support the care efforts of the PCP as possible long-term pulmonary complications from COVID-19 are anticipated. 1-week post-discharge: Review hospital record with evaluation of anticoagulation therapy, supplemental oxygen, follow-up chest imaging (x-ray or CT scan), and Pulmonary Function Testing Ensure patient is following-up with other specialists (e.g. pulmonary, cardiology, renal, hematology) who were involved with the inpatient care especially for critical organ dysfunction Carefully evaluate additional needs of immunocompromised patients. This includes those with cancer, diabetes, HIV, and those on Immune modulating medication Assess anxiety, post-traumatic care or other mental health issues that would require evaluation. Educate patient about the opportunity to donate COVID Convalescent Plasma (CCP) Screen for social influencers of health (or confirm any changes if this was done upon admission) to ensure housing, food, utility, transportation, or isolation/loneliness issues will not impede recovery o For Medicare and Medicaid patients, including managed care plans and secondary insurance, (until November 2021) use the Accountable Health Communities screening tool follow process per CMS guidelines See appendix for screening workflow, screening tool, and a sample of Cook County Resources o For all other patients, the AMITA Health Community Resources tool (available to anyone with an AMITA Health address) has a general social risk assessment tool embedded and ability to search for community resources by zip code and need domain. From your AMITA login: Open Access: AMITAHealth.org/patient-resources/community-resources Screen for palliative care needs including: o Functional status and assessment o Improvement or decline in status o Uncontrolled symptoms o Patient defined goals are they being met o Community Palliative Care evaluation after positive screen Schedule subsequent outpatient visits according to severity of illness and risk assessment (e.g. residual symptoms, critical illness, organ failure and underlying comorbidities). 2-weeks post-discharge, for higher risk patients: 10

11 Review clinical status as indicated by 1-week post-discharge visit Confirm whether any social needs have changed since prior week. No need to screen again if not. 1-month post-discharge: Continue clinical care, including repeat laboratory testing or imaging as indicated Consider cardiac and / or pulmonary rehab evaluation Educate patient about appropriate timing to donate COVID Convalescent Plasma (CCP) Ensure housing, food, utility, transportation, or isolation/loneliness issues are not impeding recovery 3-months post-discharge: Continue clinical care, including chest x-ray and repeat of any abnormal labs at 1-month Consider PFTs and CT chest with residual dyspnea or functional limitations Ensure housing, food, utility, transportation, or isolation/loneliness issues are not impeding recovery Interim visits: As needed with PCP and appropriate specialists 1-year post-discharge: Consider 1-year CT chest for comparison o Fibrotic and ground glass infiltrates are characteristic. Consider PFTs with residual dyspnea or functional limitations Ensure housing, food, utility, transportation, or isolation/loneliness issues are not impeding recovery 11

12 Behavioral Health Considerations and Resources We expect that over three quarters of adult and child patients discharged from the hospital will evidence moderate to severe emotional, behavioral and cognitive difficulties that could continue for several months to several years. Discharging patients with pre-existing psychiatric diagnoses, including mental illness, social and communication disorders, developmental and cognitive disorders, and addiction, will be especially vulnerable to on-going behavioral health issues. These patients may require emotional support, cultural sensitivity, and practical assistance in establishing behavioral health follow-up at the time of discharge planning. All discharging patients should be presented with a self-care tip sheet/links and referrals to Behavioral Health providers within the AMITA Health System. If there is geographical, cultural, age, or clinical barriers to providing these services, alternative s can be presented by behavioral health intake workers. The tip sheet will include crisis numbers. PCP s and Specialists responsible for helping patients navigate follow-up visits will, reinforce at every contact, the critical importance of behavioral health services, as well. We expect that behavioral health interventions will not only be important for the patient, but also for family members who dealt with the effects of the disease, separation, isolation, and loss. Referrals should also be provided for them. Professional counseling services: Please find below a list of locations and phone numbers for scheduling an appointment. Aurora, Bartlett, Bolingbrook, Carol Stream, Des Plaines, Elgin, Elk Grove Village, Glendale Heights, Hinsdale, Hoffman Estates, Joliet, Lake Zurich, Palatine, and Westmont: Arlington Heights Bourbonnais Chicago AMITA Health St. Joseph Hospital Chicago: Chicago AMITA Health Saints Mary and Elizabeth Medical Center Chicago: Chicago AMITA Health Chicago, 1127 Oakley Blvd.: x8510 Evanston Melrose Park x8510; Spanish Speaking Westchester x5514 Additional no-cost resources for behavioral health support in the Chicago area: N.A.M.I. help line (M-F 9 AM- 8PM; Sat and Sun 9 AM-5 PM) 12

13 Chicago Department of Public Heath Mental Health Centers teletherapy (M-F 8:30 AM-4:30PM) In Northwest Indiana, contact the Rapid Assistance Line: and select 2, then 9 for mental health support After-hours support text: HOME to to be connected with a crisis counselor 24/7 National Suicide Prevention Hotline Tips to manage anxiety and depression: Stay connected to your family and your friends. If not in-person, use the phone and social media every day. Talk with them about your feelings. Getting support from loved ones is part of the healing process Focus on what you can control. Anxiety and uncertainty about your recovery is a normal part of life. Don t be self-critical or judgmental if you are feeling down, confused, and anxious at times. This is to be expected. Keep taking safety precautions, including frequent hand washing, social distancing from non-family members, and avoiding large gatherings Discuss any emotional, behavioral or cognitive issues with your primary care doctor. You may be referred to a behavioral health provider If you are a spiritual or religious person, visit with your faith leader or member of your faith community Get plenty of rest overnight Eat well Encourage your body to relax by meditating, praying, or doing relaxing activities such as puzzles, reading, listening to music, and art projects. Telemedicine Telemedicine offers additional access and safety for your patients. Providers have access to several telehealth platforms to support scheduled virtual provider office visits, psychiatry, group session, pre and post op checks, nutrition counseling, and physical therapy. Embedded language interpreters (e.g., Zoom, Vivify, Doximity, TapCloud). AMITA is also considering American Well (AmWell), an on demand visit and virtual provider office model. AmWell allows patients to upload pictures and invite family members into the session. 13

14 Home Monitoring (e.g., AMITA Check) Home Oximeters and Thermometers may play a useful role in monitoring ongoing symptoms postdischarge. The AMITA Check platform powered by TapCloud can also be utilized by CIN providers and patients for daily symptom monitoring, virtual interaction, and patient education. See flyer below. AMITA Check, Powered by TapCloud: 14

15 Specialty Considerations Cardiology Myocardial injury can occur during COVID 19 infection including myocarditis, stress cardiomyopathy (Takotsubo's cardiomyopathy), microvascular damage, or epicardial coronary artery disease with plaque rupture. Right heart strain also can occur in setting of pulmonary embolism. These manifestations that occur through the hospital stay should be followed up as an outpatient by repeat echocardiography. Routine monitoring for myocarditis post hospitalization is not recommended unless patient's exhibit specific symptoms. Incident heart failure may be common in hospitalized patients with COVID 19 infection. This can be seen in patients with pre-existing known heart failure or undiagnosed heart failure as an incident to acute myocardial injury such as outlined above. Is important to assess volume status in the post hospital setting and treat aggressively to improve hypoxia overall. Tele health is an important post hospitalization method in which to monitor patients while also reducing exposure to office staff and healthcare providers. Appropriate use to tele health medicine is important as patients with more critical symptoms may need to be seen in person or in the emergency department. Hematology / Oncology Anticoagulation on Patient Discharge: After hospital discharge from acute medical illness, extended thromboprophylaxis can reduce the risk of VTE, at the cost of increase in bleeding events, including major bleeding. As part of discharge planning for COVID-19 patients, chronic disease states, the prior-to-admission medication list, and thrombotic/bleeding risk should be considered. The COVID-19 Post-discharge Anticoagulation Recommendations on the next page details recommendations for discharge planning in general: Patients who were on long-term anticoagulation prior to admission for another treatment indication should continue the previously prescribed medication unless contraindicated. The anticoagulation plan should be evaluated for potential need for "bridging" therapy and/or follow-up monitoring to achieve an adequate level of therapeutic anticoagulation. Patients with a newly diagnosed VTE during hospital admission should follow standard of care with therapeutic anticoagulation for 3 months. Longer duration (or chronic therapy) may be warranted based on other prothrombotic conditions and/or previous thrombotic history. While no data specific to COVID-19 exist, it is reasonable to employ individualized risk stratification for thrombotic and hemorrhagic risk, followed by consideration of extended 15

16 prophylaxis (for up to 45 days) for patients with elevated risk of VTE (e.g., reduced mobility, comorbidities such as active cancer and elevated D-dimer >2 times the upper normal limit) who have low risk of bleeding. 16

17 OBGYN The Women s Health Task Force Recommendations for OB/Laboring Patients can be found at the link below. Neonate Discharge instructions for COVID-19 Expose Well Newborn: 6/16/20 Criteria for Discharge: The neonate may be discharge if clinically stable and meets all routine AAP criteria for discharge. The neonate may be discharged without waiting for results of COVID test provided a reliable method of communication and follow up has been set up with PCP. Infant Feeding: Breast feeding may be continued with appropriate infection-prevention measures in place a. Mother chooses to directly breast feed: Mother should practice proper hand and breast hygiene and wash with soap and water prior to handling the baby. Mother should wear a mask while holding the baby skin to skin and while breast feeding. b. Mother chooses to express breast milk: Mother should practice hand and breast hygiene and clean parts of the breast pump and artificial nipples. Mother should express milk as often as the baby would eat, at least 6-8 times in 24 hours, or more frequently if needed. The expressed breast milk can be fed to the infant by a healthy and un-infected caregiver. c. Mother chooses not to breast feed: Appropriate education about benefits of breast feeding should be discussed with mother prior to discharge. An in-person follow up visit is recommended within hours of discharge for infant exam, weight check and breast-feeding support. Care of Infant at Home: 1. Mother with COVID-19 should maintain a distance of at least 6 feet from the newborn. 2. When in closer proximity, she should use a mask. She should practice hand hygiene prior to handling the infant for newborn care. 3. It would be helpful if the infant has the support of a designated uninfected caregiver. 4. Other care givers in the home who are persons under investigation should use masks when within 6 feet of the newborn and should use hand hygiene before and after contact with the infant. 5. Caregivers should seek immediate medical attention for the infant if baby becomes symptomatic at any time. Discontinuation of Isolation Precautions: The above isolation precautions for the mother can be discontinued when: 1. Mother is afebrile for 72 hours without use of antipyretics 17

18 1. AND ii. At least 10 days have passed since the symptoms first appeared. 1. OR 2. IN THE CASE OF AN ASYMPTOMATIC WOMAN identified to be COVID positive on screening tests at least 10 days have passed since the positive test 1. OR 3. Mother has negative results of 2 consecutive COVID tests done 24 hours apart. Follow-up: 1. If the Infant s SARS CoV-2 test is positive: If the infant is asymptomatic, plan for frequent outpatient follow up for at least 14 days after birth either in-person or phone or telemedicine. 2. If Infant s SARS CoV-2 is negative: Routine care for the infant, maintaining precautions at home. 3. If infant could not be tested: Infant must be treated as if virus positive for 14 day period of observation. If the in-person follow up visits with PCP cannot be arranged, arrangements can be made for the family to be obtained an infant weight scale and thermometer prior to discharge. References: Pediatrics COVID-19 pediatric discharge criteria: 1. Resolution of hypoxia, respiratory distress 2. Hemodynamic stability 3. Ability to maintain oral intake Follow up for COVID-19 pediatric patients: Follow up with PCP hours after discharge 18

19 Isolation measures for COVID-19 pediatric patients Asymptomatic, SARS-CoV2 + o Isolation x 10 days from date of diagnosis Symptomatic, SARS-CoV2+ o Isolation x 10 days since symptom onset AND afebrile x 72 hours without use of antipyretics AND respiratory symptoms improved Exposed to a SARS-CoV2+ individual o Isolation x 14 days from exposure Kawasaki With the emergence of MIS-C (multi-system inflammatory syndrome in children), special attention should be paid to pediatric patients who present with > 24 hours of fever, signs/symptoms consistent with Kawasaki's Disease and/or GI symptoms. These children require immediate evaluation with specific attention to blood pressure and inflammatory markers as there can be rapid deterioration. Children with MIS-C will mostly require intensive care support. Dermatology Some patients with COVID-19 present with Pernio-like lesions of fingers and toes. Additionally, others experience viral induced rashes, such as morbilliform, or urticaria. Consult Dermatology as needed. Ophthalmology Ocular manifestations of the virus are cultured in only a small percent of COVID-19 positive patients. However, it may be seen in a significant percent of patients with more severe systemic disease. Symptoms may include conjunctivitis, conjunctival hyperemia, chemosis, epiphora, and increased secretions. 19

20 Testing and Convalescent Plasma Testing Patients discharged to home should maintain home isolation, observing transmission-based precautions in accordance with current CDC recommendations. Discontinuation of these precautions should follow one of two strategies outlined by CDC, using either the Symptom or Test based Strategy. For most patients, the symptom-based strategy is recommended, because of the reported incidence of prolonged shedding of virus after recovery in some patients* that may not be clinically significant. However, some employers or living facilities may insist on the testbased strategy before patients can return. Discontinuation of these precautions is based on: a) Symptom-based strategy: At least 3 days (72 hours) have passed since recovery defined as resolution of fever without fever-reducing medications AND improvement in respiratory symptoms (reduced or resolved cough, shortness of breath) AND at least 10 days have passed since symptoms first appeared OR b) Test-based strategy: Resolution of fever without fever-reducing medications AND improvement or resolution of respiratory symptoms (cough, shortness of breath) AND negative results of an FDA Emergency Use Authorized Covid-19 molecular assay for detection of SARS-CoV-2 RNA from at least 2 consecutive nasopharyngeal swab specimens collected >= 24 hours apart using the High Sensitivity option (not the rapid test). *Patients hospitalized may have longer periods of COVID-19 detection compared to patients with mild or moderate disease. Severely immunocompromised patients may also have longer periods of COVID-19 detection and prolonged shedding of virus / infectious recovery. The provider may elect to continue home isolation, transmission-based precautions for longer time periods based on a patient s underlying medical condition and persistence of COVID-19 symptoms post discharge. Convalescent Plasma Patients who have recovered from COVID-19 have the opportunity to donate their plasma which can be lifesaving to others who are suffering from the illness. Plasma from patients who have recovered from COVID-19 contains important viral neutralizing antibodies. These antibodies, when transfused into a patient suffering from severe COVID-19, can help to destroy the virus and promote a quicker recovery. Each donation you make can be used to treat up to 3 patients in the hospital. Information about who to contact to make this potentially life-saving donation is attached. 20

21 See appendix for Spanish, Polish, and Arabic translations. 21

22 Mass Mailing Distribution A one-time mailing will be going out on or around July 7 th to all approximately 3,000 patients who have previously been discharged from an AMITA Health facility with COVID-19. The letter will be provided in both English and Spanish. It will encourage patients to connect with a PCP as soon as possible and will include self-care tips and information to access free and discounted behavioral and community health resources (e.g., housing, food, transportation, etc.). See screenshots below. Page 1: Main Letter Page 2: Community Health Resrouces Page 3: Behavioral Health Resources 22

23 Appendix Accountable Health Communities Screening Tool Process 23

24 Accountable Health Communities Screening Tool 24

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26 Re 26

27 SAMPLE: Community Resources There are 12 of these based on upon geolocation of POC Contact for more detail 27

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29 Convalescent Plasma Flyer: Spanish 29

30 Convalescent Plasma Flyer: Polish 30

31 Convalescent Plasma Flyer: Arabic 31

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