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Document Type
Rapid Review
Review Code
CC120301 RR
Question Submitted
December 3, 2020
Date Completed
December 10, 2020
Status
3. Completed
Research Team
Critical Care
., 200% or 300% over capacity) and health care facilities must triage COVID patients, at what level
Document Type
Rapid Review
Review Code
CC120301 RR
Question Submitted
December 3, 2020
Date Completed
December 10, 2020
Status
3. Completed
Research Team
Critical Care
Key Findings
No studies directly evaluated the association between level of surge capacity and quality of care indicators for COVID-19 patients. However, in more broad studies, the findings suggest that mortality and other adverse events increase when the strain on the intensive care capacity increases.
A tiered staffing strategy is recommended to meet surge capacity needs in the ICU: High critical care nurse to patient ratios (1:1 or 1:2) are recommended to provide high quality patient care.
There is a lack of high-quality evidence to support ICU triage protocols tailored for patients with COVID-19. Nevertheless, the protocols must be flexible, adaptable according to the availability of local resources, and effective for inter-hospital patient transfer.
While the Crisis Standards of Care (CSC) guidelines (e.g., Saskatchewan’s Critical Care Resource Allocation Framework, published on September 2020) can be used to triage newly admitted COVID-19 patients requiring critical care, there is contradicting evidence about using the Sequential Organ Failure Assessment (SOFA) score for ICU triage of patients with COVID-19.
The literature suggests the use of mathematical modeling to support capacity planning (e.g., very low, low, medium, and high intensity patient surge response)
To relieve pressure from ICUs, other types of units (e.g., Step Down Unit [SDU] or Surge Clinic) can be implemented.
Category
Administration
Healthcare Services
Subject
Health Planning
Facilities
Triage
Population
All adults
Clinical Setting
ICU
Priority Level
Level 1 2-3 days
Cite As
Azizian, A; Valiani, S; Groot, G; Badea, A; Miller, L; Howell-Spooner, B. At what level of surge capacity do quality of care indicators suffer? 2020 Dec 10; Document no.: CC120301 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 17 p. (CEST rapid review report)
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Document Type
Table
Review Code
CC120301 RR Table
Question Submitted
December 3, 2020
Date Completed
December 10, 2020
Status
3. Completed
Research Team
Critical Care
://www.ncbi.nlm.nih.gov/pubmed/32306408 2020 All Australian ICUs and veterinary facilities Analysis of Australian and New
Document Type
Table
Review Code
CC120301 RR Table
Question Submitted
December 3, 2020
Date Completed
December 10, 2020
Status
3. Completed
Research Team
Critical Care
Category
Administration
Healthcare Services
Subject
Health Planning
Facilities
Triage
Population
All adults
Clinical Setting
ICU
Priority Level
Level 1 2-3 days
Cite As
Azizian, A; Valiani, S; Groot, G; Badea, A; Miller, L; Howell-Spooner, B. At what level of surge capacity do quality of care indicators suffer? 2020 Dec 10; Document no.: CC120301 RR Table. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 17 p. (CEST table)
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CC120301 RR Table

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Document Type
Evidence Search Report
Review Code
CC120301-01 ESR
Question Submitted
December 3, 2020
Date Completed
December 4, 2020
Status
3. Completed
Research Team
Critical Care
Document Type
Evidence Search Report
Review Code
CC120301-01 ESR
Question Submitted
December 3, 2020
Date Completed
December 4, 2020
Status
3. Completed
Research Team
Critical Care
Category
Administration
Healthcare Services
Subject
Health Planning
Facilities
Triage
Population
All adults
Clinical Setting
ICU
Priority Level
Level 1 2-3 days
Cite As
Miller, L; Howell-Spooner, B. At what level of surge capacity do quality of care indicators suffer? 2020 Dec 4; Document no.: CC120301-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 50 p. (CEST evidence search report)
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Document Type
Rapid Review
Review Code
CC120401 RR
Question Submitted
December 4, 2020
Date Completed
December 17, 2020
Status
3. Completed
Research Team
Critical Care
Document Type
Rapid Review
Review Code
CC120401 RR
Question Submitted
December 4, 2020
Date Completed
December 17, 2020
Status
3. Completed
Research Team
Critical Care
Key Findings
· There is little literature on the performance of triage frameworks. However, critiques of frameworks can help to inform the development of future protocols. · It is ethically problematic to include age as a triage factor rather than the more nuanced factors of frailty and chronic comorbidities. · The public should be included when creating triage protocols to create transparency and trust in the health system. · Healthcare providers should be familiar with the ethical decisions that have been made in establishing the protocols. However, using a triage team to make decisions about resource allocation would alleviate moral burden from clinicians. · Regular review of current guidelines, such as the use of SOFA scores, is recommended as knowledge about COVID-19 changes. Rapid Review Report: CC120401 RR (Version 1: December 17, 2020 11:45) 2 · Patients should be regularly reassessed to allow for timely redistribution of critical resources.
Category
Administration
Healthcare Services
Subject
Health Planning
Facilities
Triage
Population
All
All adults
Clinical Setting
ICU
Priority Level
Level 3 Two weeks (14 days)
Cite As
Fick, F; Valiani, S; Miller, L; Howell-Spooner, B. Does data exist on the performance of triage or resource allocation frameworks for COVID-19 and other pandemics? 2020 Dec 17; Document no.: CC120401 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 91 p. (CEST rapid review report)
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Document Type
Evidence Search Report
Review Code
CC120401-01 ESR
Question Submitted
December 4, 2020
Date Completed
December 8, 2020
Status
3. Completed
Research Team
Critical Care
and Triage Tool for Medical Treatment Facilities With Limited Resources. Mil med. 2020. URL: https
Document Type
Evidence Search Report
Review Code
CC120401-01 ESR
Question Submitted
December 4, 2020
Date Completed
December 8, 2020
Status
3. Completed
Research Team
Critical Care
Category
Administration
Healthcare Services
Subject
Health Planning
Facilities
Triage
Population
All
All adults
Clinical Setting
ICU
Priority Level
Level 3 Two weeks (14 days)
Cite As
Miller, L; Howell-Spooner, B. Does data exist on the performance of triage or resource allocation frameworks for COVID-19 and other pandemics? 2020 Dec 8; Document no.: CC120401-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 20 p. (CEST evidence search report)
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Document Type
Evidence Search Report
Review Code
LTC042201-01 ESR
Question Submitted
April 22, 2020
Date Completed
24-Apr-2020
Status
3. Completed
Research Team
Long Term Care
QUESTION: What human resources are required in long term care facilities to mitigate or control an ILI
Document Type
Evidence Search Report
Review Code
LTC042201-01 ESR
Question Submitted
April 22, 2020
Date Completed
24-Apr-2020
Status
3. Completed
Research Team
Long Term Care
Category
Administration
Infection Prevention and Control
Subject
Facilities
Health Planning
Long Term Care
Elderly
Population
Aged (80+)
Other
Clinical Setting
Long Term Care
Priority Level
Level 3 completed within 2-3 days
Cite As
Tupper, S; Ward, H; Dalidowicz, M; Boden, C; Ellsworth, C; How can LTC facilities prepare for a pandemic? 2020 Apr 29; Document no.: LTC042201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 27 p. (CEST evidence search report)
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Document Type
Rapid Review
Review Code
LTC042201 RR
Question Submitted
April 22, 2020
Date Completed
April 29, 2020
Status
3. Completed
Research Team
Long Term Care
Review Title: How can LTC facilities prepare for a pandemic? Keyword Title: LTC Preparedness Checklist
Document Type
Rapid Review
Review Code
LTC042201 RR
Question Submitted
April 22, 2020
Date Completed
April 29, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
· Overall, there is a lack of high quality evidence to support recommended pandemic preparedness strategies (checklist items) to prevent or mitigate respiratory infection outbreaks in LTC. · In the absence of high-quality or mixed evidence to support strategies for pandemic preparedness, it is advisable to follow clinical practice guideline recommendations that have been based on expert opinion (key sources are identified in red). This is particularly the case for infection control interventions that are likely to have no negative impacts on LTC residents (e.g. hand hygiene, cough etiquette). Strategies that have a potential negative impact on LTC residents (e.g. visitor restrictions) must be handled with more flexibility and individual assessment to determine how infection control can be preserved while minimizing negative consequences for residents and families. · Internationally recognized pandemic/outbreak preparedness checklists for LTC (e.g. CDC 2020, Buynder et al. 2017) share many similarities to the current SHA Annex R checklists. · Consideration should be given to converting the checklist into a planner with accountabilities to demonstrate how each item is being addressed (similar to CDC 2020). Links can be embedded in the planner/checklist to more detailed information, such as the PPE burn calculator (CDC 2020), education/training materials (WHO 2020), and communication materials for families (CDC 2020, WHO 2020, Buynder et al. 2017). · Consider the addition of specific detail to the SHA pandemic preparedness checklists on the date of the next pandemic plan/checklist review, contact names for local resource acquisition or assistance with staffing, tracking forms for dates of education/training with staff and residents, tracking of audits/observation of infection control practices, surge capacity planning items, and expanded items for communication (see attached recommendations from family caregivers of the Saskatchewan LTC Network). · Discrepancies exist between reported (77-100%) and observed (25-63%) adherence to infection control practices, indicating a need for independent audits. Adherence rates improve with direct observation, frequent education reminders and prompts. · Even when there is not an outbreak in a home, the pandemic response results in increased workload demands on staff due to infection control practices (e.g. PPE and hand hygiene), loss of family caregiver assistance with resident care, enhanced care needs of residents due to anxiety, increased communication with family caregivers and other members of the care team, monitoring and restricting resident movement in the home, enhanced cleaning, staff absenteeism, and education/training. Consideration is needed for a provincial process for evaluation of needs within individual homes, and allocation of additional human resources, disposable supplies, equipment, or funding to ensure that both infection control and usual care needs of residents are consistently met. · Maintaining public confidence through communication is a defined infection control strategy. Communication strategies include individual communication between family members and staff, public communication strategies by individual facilities and provincially through dedicated pandemic information pertaining to LTC (e.g. dedicated LTC section on provincial websites).
Category
Administration
Infection Prevention and Control
Subject
Facilities
Health Planning
Long Term Care
Elderly
Population
Aged (80+)
Other
Clinical Setting
Long Term Care
Priority Level
Level 3 completed within 2-3 days
Cite As
Tupper, S; Ward, H; Dalidowicz, M; Boden, C; Ellsworth, C; How can LTC facilities prepare for a pandemic? 2020 Apr 29; Document no.: LTC042201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 27 p. (CEST rapid review report)
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Document Type
Evidence Search Report
Review Code
EOC033003-01 ESR
Question Submitted
March 30, 2020
Date Completed
March 30, 2020
Status
3. Completed
Research Team
EOC
Document Type
Evidence Search Report
Review Code
EOC033003-01 ESR
Question Submitted
March 30, 2020
Date Completed
March 30, 2020
Status
3. Completed
Research Team
EOC
Notes
This was never assigned to an RR
Category
Healthcare Services
Administration
Subject
Health Planning
Facilities
Acute Care
Modeling
Population
All
Priority Level
Level 2 completed within 8 hours
Cite As
Howell-Spooner, B. How do we decrease surge demand in acute care? 2020 Mar 30; Document no.: EOC033003-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 10 p. (CEST evidence search report)
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Document Type
Evidence Search Report
Review Code
LTC042402-01 ESR
Question Submitted
April 24, 2020
Date Completed
April 28, 2020
Status
3. Completed
Research Team
Long Term Care
Recommendations Saskatoon Ministry of Health. Outbreaks in Long Term Care and Integrated Facilities - Generic
Document Type
Evidence Search Report
Review Code
LTC042402-01 ESR
Question Submitted
April 24, 2020
Date Completed
April 28, 2020
Status
3. Completed
Research Team
Long Term Care
Category
Administration
Healthcare Services
Subject
Facilities
Long Term Care
Palliative Care
Infection Prevention and Control
Family
Population
All
Clinical Setting
Cardiac unit
Emergency
ICU
Long Term Care
Medicine Unit
NICU
Oncology
Priority Level
Level 4 completed within 1 week
Cite As
Howell-Spooner, B; Dalidowicz, M; Boden, C. How is "compassionate visit" defined and operationalized in the context of an infectious outbreak or pandemic? 2020 Apr 28; Document no.: LTC042402-01 ESR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 7 p. (CEST evidence search report)
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Document Type
Rapid Review
Review Code
LTC042402 RR
Question Submitted
April 24, 2020
Date Completed
April 30, 2020
Status
3. Completed
Research Team
Long Term Care
- measures/guidance- for-health-care- facilities All ages/all settings Descriptive (government public
Document Type
Rapid Review
Review Code
LTC042402 RR
Question Submitted
April 24, 2020
Date Completed
April 30, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
Visitor restrictions in long-term care (LTC) during an outbreak or pandemic are implemented due to the perceived risk of transmission between residents or staff and visitors. · Social isolation and possible loss of care resulting from visitor restrictions in LTC may place residents at risk of poorer outcomes in terms of both physical and mental health, as well as distress to families and staff (see Saskatchewan LTC Network Family Perspective). · Visitor restriction policies typically allow visits for compassionate reasons that include end of life, critical care, and support of persons who require assistance beyond that provided by healthcare e.g. support for feeding, mobility, or behaviors, but specific detail on these is not consistent or clear. · Recent changes to visitation policies in Australia are less restrictive and allow brief visitations (end of table 1, noted in red font). · Although the majority of policies describe a need for flexibility and case-by-case assessment of visits deemed “essential”, the majority of policies are not clear in who is to conduct this analysis or the criteria that should be used to make these decisions. Visitation policies differ in detail regarding the number of visitors allowed at one time, total number of visitors allowed, visit duration, mobility within the home and location of the visit. · Remote and technology assisted visits are to be facilitated by LTC staff. · Infection control practices are enforced for visitors, and may include screening (e.g. temperature, symptoms, travel and contact history), prohibiting ill visitors, use of personal protective equipment (PPE), hand and cough hygiene. · Education of visitors and support for proper infection control practices is encouraged in the majority of policies.
Category
Administration
Healthcare Services
Subject
Facilities
Long Term Care
Palliative Care
Infection Prevention and Control
Family
Population
All
Clinical Setting
Cardiac unit
Emergency
ICU
Long Term Care
Medicine Unit
NICU
Oncology
Priority Level
Level 4 completed within 1 week
Cite As
Tupper, S; Ward, H; Howell-Spooner, B; Dalidowicz, M; Boden, C. How is "compassionate visit" defined and operationalized in the context of an infectious outbreak or pandemic in long-term care? 2020 May 1; Document no.: LTC042402 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 17 p. (CEST rapid review report)
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45 records – page 1 of 5.