Outpatient clinics – scheduled and drop in clinics

Local health districts will decide on the resumption of face to face outpatient clinics based on the local epidemiology of the disease.

Context

Outpatient services are generally provided in a clinic setting at a hospital or community health centre where patients can consult specialist medical practitioners, have tests or other procedures, or receive treatment from specialist nursing teams and allied health, such as physiotherapy and social work.

Management of patients prior to outpatient appointments should be according to current public health guidance for testing and home isolation.

Outpatient clinics should review models of care and incorporate risk assessment and mitigation processes that include:

  • Screening of patients for symptoms prior to attendance, at entry to the facility, +/- booking in/reception and as part of routine clinical assessment. Anyone who is symptomatic or has a temperature should be advised to access testing at an appropriate location. Patients who are referred for testing should have their appointment delayed or conducted via an alternative method (e.g. tele-medicine) unless clinical urgency dictates otherwise.
  • Use signage at entrances and in waiting areas about physical distancing, hand and respiratory hygiene and reporting to reception if unwell. See all COVID-19 resources for culturally and linguistically diverse communities.
  • Measures to encourage physical distancing to ensure 1.5 metres of space between people where appropriate and practical. However, household members who are normally in close contact should be permitted to sit together. Encourage 1.5 metres physical distancing in waiting rooms and at reception desks e.g. spacing chairs, floor markings and signage.
  • Measures to encourage good personal hygiene, including access to hand washing facilities and/or hand sanitiser and signage to encourage hand hygiene and cough etiquette.
  • Patients with new COVID-19 like symptoms (fever, cough, shortness of breath, sore/scratchy throat, or loss of smell or taste) or known to have confirmed COVID-19 should be asked to present wearing a mask where clinical urgency dictates the appointment should proceed. If they present without one, a mask should be made available on arrival.
  • Prior to the patient attending the outpatient appointment request where possible they only bring 1 support person to the waiting area to minimise the number of people in the waiting area and at the appointment.
  • Ensure all staff have completed infection prevention and control training, including practical personal protective equipment training where relevant.
  • Continue to prioritise alternative virtual 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. Guidance in relation to telehealth is available at ACI - Telehealth.

More information in regards to preparation of community health centres and outpatient settings for patient visits is available at Clinical Excellence Commission - COVID19 Guidance for Community Primary and Outpatient Settings.

Before attendance at outpatient clinics

Pre-screening patients prior to the patient presenting at the outpatient appointment

Develop a system, prior to attendance (e.g. phone call, SMS), to pre-screen patients for risk criteria. Where risk criteria are identified, outpatient clinics should ensure systems should be in place to manage patients appropriately, including appointing an appropriate person (e.g. a senior clinician) to assess whether or not it is safe to defer the outpatient appointment where risk criteria are identified.

Patients should be asked:

  • Have you ever been diagnosed with COVID-19?
  • Have you had any symptoms in the last 14 days that are new:
    • fever (≥37.5°C) or history of fever (e.g. night sweats, chills)
    • cough
    • shortness of breath
    • sore/scratchy throat
    • loss of smell or loss of taste
  • Have you been in contact with anyone diagnosed with COVID-19, travelled internationally or on a cruise ship as a passenger or crew, travelled to an area within Australia considered high risk for community transmission in the last 14 days?

As of 8 July, advice on current areas of concern is at Public health advice for people who have travelled from Victoria in the last 14 days.

Given the evolving situation, services should regularly monitor NSW Health - COVID-19 for updates.

Reviewing the timing and mode of appointment based on risk criteria screening

  • Consider alternate of methods of conducting the appointment if appropriate (e.g. tele-health).
  • If it is not possible to conduct the outpatient appointment in an alternate way and it is not clinically urgent, reschedule the appointment (refer to release from isolation to determine when the patient can attend an appointment).
  • If the appointment is rescheduled, consider follow up phone calls with the client prior to the time of release from self-isolation in order to determine the outcome of medical assessment, if there is a change in circumstances and to monitor their needs.
  • If screening and appointment scheduling is performed by a non-clinical staff member and risk criteria are identified this should be escalated to the responsible clinician for further assessment as to whether it is clinically appropriate to defer the appointment and what other management may be required.

At the time of outpatient attendance

Screening patients at the outpatient clinic

 On arrival re screen patients for symptoms at the booking in for the appointment and as part of routine clinical assessment

  • Consideration should be given to patients who may be poor historians and may not have capacity to answer COVID-19 screening or risk assessment questions accurately.
  • Use waiting room signage to encourage patients with symptoms or who have had close contact with a person with confirmed COVID-19 while infectious or who have returned from overseas or on a cruise boat in the previous 14 days to self-identify to clinic staff.

Outpatient attendance for patients who meet the screening criteria

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Page Updated: Wednesday 8 July 2020
Contact page owner: Health Protection NSW