- Assess current symptoms and change (better / worse). See symptoms / atypical symptoms in history section above.
- Vitals – patient to record until symptoms resolve
- once daily T, BP (if patient has access to a cuff)
- twice daily HR, RR, +/- SPO2
- Assess level of dyspnoea (see Examination/Remote Examination on this page for tips on assessing dyspnoea virtually)
- Check urine output and fluid intake
- Check for respiratory and other red flag symptoms (See When to Refer to ED section)
- Severe shortness of breath at rest
- Difficulty in breathing
- Increasing significant fatigue (reported in some patients as a marker for hypoxemia without dyspnea)
- Blue lips or face
- Cold, clammy, or pale and mottled skin
- Reduced level of consciousness or new confusion
- Little / no urine output
- Pain or pressure in the chest
- Note underlying chronic disease that indicates increased risk. For patients with diabetes increase to daily monitoring.
- Assess need for regular medication changes or advice (see “management” tab below).
- Check mental health, access to food, support or carer, financial or housing stress.
- Assess whether this patient can still be managed at home (see When to Refer to ED tab: consider whether goals of care conversation is appropriate).
For patients who are COVID+ that you may have questions about their acute care or potential need to transfer to ED. SJHH and HHS have offered the following specific support:
- At SJHH: an Emergency Physician at SJHH is available daily from 4-5 to provide any advice and support needed. To contact this physician, call the SJHH ED at 905-522-1155 x 32043 and a clerk will provide the contact number to connect directly with the ED physician covering that day
- At Hamilton Health Sciences: Family Physicians can reach out to the on-call physician for the Connected Health Hamilton program at HHS by calling the Virtual Command Centre 7 days a week at: 905 577 1409. The VCC nurse will then take the contact details of the Family Medicine doctor and will convey the message to the on-call doctor during their daily check-in (usually between 1pm-2pm unless they have a conflict). The on-call doctor will call the Family Physician directly to discuss any issues /provide support. Give detailed management advice (see management tab below)
- Set up time for next follow-up – If follow-up falls on weekend make plan for this.
You can download EMR templates of this COVID monitoring pathway, with embedded links to hfam, from the EMR tools section of HFAM.
Here also is an example of a monitoring template you could use all or parts of to track all your clinic patients. Download or save a copy of this template.