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Context

Management of patients prior to community-based appointments and home visits should be according to current public health guidance for testing and home isolation.

Community-based services should review models of care and incorporate risk assessment and mitigation processes that include:

  • Screening of patients for symptoms prior to attendance as part of routine clinical assessment. Anyone who is symptomatic or has a temperature should be advised to access testing at an appropriate location.
  • Measures to encourage physical distancing to ensure 1.5 metres of space between people where appropriate and practical whilst providing a service. This will include minimising the number of household members who share the room in which the service is provided (it is recommended that babies and young children are accompanied by one parent/carer) and minimising close contact during the provision of service.
  • Measures to ensure standard infection prevention and control precautions are stringently followed. The Clinical Excellence Commission COVID-19 Infection Prevention and Control Guidance for Home Visits should be followed.
  • Prioritise alternative models of care such as use of telemedicine technology where appropriate, especially for people who are vulnerable to severe illness such as elderly or immunocompromised people.

Community-based health services

Community-based health services include activities occurring in:

  • Home visits including:
    • hospital in the home
    • acute care/post-acute care
    • midwifery home visits
    • early childhood health screening
    • palliative care
    • other services.
  • Scheduled clinics and drop-in clinics including:
    • hospital based non-admitted clinics
    • community health centre clinics
    • HealthOne Centres.

Patient includes patient, household members, carers and others who may be present at the time of the service.

Guidance for home visiting

Before the home visit

In addition to usual work health and safety assessment, community health care providers should conduct routine risk assessment prior to home visiting.

Screening patients prior to the outpatient appointment

Develop a system, prior to home visiting (e.g. phone call, SMS), to ask patients whether they have:

  1. Ever been diagnosed with COVID-19 disease?
    • For people who have had COVID-19, ask date of diagnosis and time since recovery
      • Organise COVID-19 clearance testing in accordance with national guidelines regarding release from isolation and advice from the Clinical Excellence Commission.
  2. Any symptoms suggestive of COVID-19: fever (≥37.5°C) or history of fever (e.g. night sweats, chills) or acute respiratory infection (e.g. cough, shortness of breath, sore throat) or a combination of other non-specific symptoms (headache, tiredness, muscle pain, runny nose, loss of sense of taste or smell, diarrhoea, nausea/vomiting or loss of appetite)
    • If the patient has symptoms, support the patient to get tested if they have not already done so:
    • If the patient has no symptoms, remind them if they develop new respiratory symptoms or fever to call healthdirect on 1800 022 222 or their GP for advice

    Clinical and public health judgement should be used when considering testing individuals with the other non-specific symptoms for COVID-19 and may depend on other risk factors for infection (CDNA National guidelines for public health units).

  3. Had contact with a person with confirmed COVID-19 while infectious, travelled internationally or been on a cruise, in the 14 days before the scheduled home visit appointment
    • Advise the patient to seek testing if they have any new symptoms
    • Remind them they are to self-isolate at home for 14 days since last contact with the person with confirmed COVID-19 whilst infectious or after they returned from travelling internationally or on a cruise.

The outcome of this assessment screening should be documented in the patient’s medical record.

Reviewing the appointment

If the patient meets any of the above criteria:

  • consider alternate of methods of conducting the home visit if appropriate (e.g. telephone or tele-medicine) to minimise risk of transmission to health service providers.
  • if it is not possible to conduct the home visit in an alternate way, reschedule their home visit unless it is clinically necessary to proceed.
  • reschedule the home visit for as soon as possible after a negative test or the 14-day exclusion if they have been identified as a close contact or a returned traveller.
  • if it is clinically necessary to conduct the home visit providers must follow measures outlined in the Clinical Excellence Commission COVID-19 Infection Prevention and Control Guidance for Home Visits.
  • For additional infection control procedures, see: Keep Patients Safe: COVID-19 Resources.

For patients who are well and do not meet the COVID-19 risk criteria, the visit may proceed ensuring that service delivery is consistent with the most current infection control advice.

Note, services will need to develop a system to implement the above steps, including appointing an appropriate person to assess whether or not it is safe to defer the home visit appointment and communicating with relevant partner service organisations.

At the time of the home visit

Implement a process to actively identify patients who meet the screening criteria prior to entering the patient’s home.

For patients who meet the screening criteria

  • if it is clinically appropriate to conduct the appointment, consider alternate methods of conducting the appointment, or ask the patient to wear a surgical mask and conduct the appointment while following appropriate infection control procedures. Refer to Clinical Excellence Commission COVID-19 Infection Prevention and Control Guidance for Home Visits for detailed information. Guidance include standard precautions, as well as contact and droplet precautions, hand hygiene, environmental cleaning and usual waste management.
  • remind the patient that they should self-isolate at home for 14 days after they returned or have had contact with a person with confirmed COVID-19 while infectious.
  • For patients who meet the above criteria and who report new symptoms, support the patient to get tested if they have not already done so:

Guidance for scheduled clinics and drop-in clinics

Consider options to identify people at risk in the waiting area/service provision environment, such as:

  • waiting room signage with translation
  • asking patients at reception whether they, or the person(s) attending the appointment with them, meet the risk criteria
  • identify a containment area in the centre for any person(s) who arrive with symptoms.

Refer to Guidance for outpatient clinics for more detailed information.

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Page Updated: Thursday 28 May 2020
Contact page owner: Health Protection NSW