Potential Scenarios when applying the new case definition and testing strategy
ALL PATIENTS CONSIDERED FOR SWABBING MUST MEET CLINICAL CASE DEFINITION Does the patient meet the Higher Index of Suspicion (HIS) criteria as follows? Either, in the 14 days prior to onset of illness have: • • • • •
had contact with a confirmed or probable case, had international travel, had direct contact with a person who has travelled overseas (includes Customs and Immigration & quarantine/isolation facilities staff), worked on an international aircraft or shipping vessel or cleaned at an international airport or maritime port in areas/conveniences visited by international arrivals, or any other criteria requested by the local Medical Officer of Health.
Patient A – meets clinical case definition and HIS criteria Diagnostic Swab required & funded
Patient B – meets clinical case definition but no HIS criteria. Surveillance Swab offered to patient & funded Offer swab for surveillance purposes
Requires swab, does not need examination
Requires examination including swab
Must identify on Pathlab & Halcyon form they meet HIS criteria
See in full PPE – with change of PPE and full decontamination of clinic space afterwards
Tier 1 - virtual assessment and refer to Pathlab
Tier 3 – full assessment
If swabbed at GP Tier 2 – simple assessment
Swab completed. Patient must then wait until they have negative swab result and no symptoms for 48 hrs before return to work. In interim patient must be in strict isolation. All patients notified to Public Health by GP. Swab is for diagnostic purposes.
Does not require examination, funded swab can be offered
Requires examination, funded swab can be offered *See note below
Tier 1 - virtual assessment. Refer to Pathlab if swab needed.
Tier 2 – simple assessment. Exam only or Exam + swab.
If seen at GP is Tier 2 – simple assessment. Assessment only or Assessment + swab.
PPE does not need to be changed between pts.
Refuses swab:
Swab completed.
Patient must selfisolate. GP to notify public health who will advise further steps
Patient must then to stay home until well before returning to work/school. Swab is for surveillance purposes only.
Swab can be undertaken at Pathlab or GP
No swab completed. Patient must stay home until well before returning to work/school.
* This is going to be the group where there is most ‘discussion’. Potentially you could see them in clinic in mask/hygiene and send to Pathlab and claim Tier 2 OR see in clinic – examine in mask/gloves then if needed swab in full PPE through your in house clinic and still claim Tier 2.
WBOP PHO July 01 2020
Version 2