COVID-19 Procedure: Discharge Standards and Follow-up Plan for COVID-19 Patients:

COVID-19 Procedure: Discharge Standards and Follow-up Plan for COVID-19 Patients

This process template is part of our COVID-19 Procedures pack. 

It is built as a reproduction of the procedures outlined in the Handbook of COVID-19 Prevention and Treatment (2020) produced by The First Affiliated Hospital, Zhejiang University School of Medicine (FAHZU). 

FAHZU had great success in combatting the novel Coronavirus COVID-19 and this handbook outlines best-practices, procedures, and useful charts for hospitals and medical centers to practically employ. 

The items contained within the handbook were compiled according to clinical experience. 

You can edit this process template to adapt it to the specific needs of your institution. When you come to follow the procedure, you can run this template as a checklist. You can add form fields throughout the checklist to gather information. You can connect your Process Street account with other platforms via automation to automatically store or utilize any data entered into your checklists. 

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You can find the full handbook embedded below.

Process Street is not a medical institution and the items contained in this process template are illustrative and not intended to be understood as medical advice. Please refer to the attached PDF document for any and all medical or operational recommendations. 

Enter checklist details

Pre-Discharge:

Check patient status against discharge standards

  • 1
    Body temperature remains normal for at least 3 days (ear temperature is lower than 37.5 °C)
  • 2
    Respiratory symptoms are significantly improved
  • 3
    The nucleic acid is tested negative for respiratory tract pathogen twice consecutively (sampling interval more than 24 hours); the nucleic acid test of stool samples can be performed at the same time if possible
  • 4
    Lung imaging shows obvious improvement in lesions
  • 5
    There is no comorbidities or complications which require hospitalization;
  • 6
    SpO2 > 93% without assisted oxygen inhalation
  • 7
    Discharge approved by multi-disciplinary medical team

Assess the need for medication after discharge

Generally, antiviral drugs are not necessary after discharge. Treatments for symptoms can be applied if patients have a mild cough, poor appetite, thick tongue coating, etc. Antiviral drugs can be used after discharge for patients with multiple lung lesions in the first 3 days after their nucleic acid are tested negative.

Refer self-isolation measures

Patients must continue two weeks of isolation after discharge. Recommended home isolation conditions are:

  • 1
    Independent living area with frequent ventilation and disinfection
  • 2
    Avoid contacting with infants, the elderly and people with weak immune functions at home
  • 3
    Patients and their family members must wear masks and wash hands frequently
  • 4
    Body temperature is taken twice a day (in the morning and evening) and pay close attention to any changes in the patient's condition.

Arrange the follow-up appointments

A specialized doctor should be arranged for each discharged patient's follow-ups. The first follow-up call should be made within 48 hours after discharge. The outpatient follow-up will be carried out 1 week, 2 weeks, and 1 month after discharge. Examinations include liver and kidney functions, blood test, nucleic acid test of sputum and stool samples, and pulmonary function test or lung CT scan should be reviewed according to the patient's condition. Follow-up phone calls should be made 3 and 6 months after discharge.

Discharged patient asymptomatic:

Send home to isolation

Perform 48 hour follow-up call

Patient name: {{form.Patient_name}}

Patient ID: {{form.Patient_ID}}

Patient birth date: {{form.Patient_birth_date}}

Patient details: {{form.Patient_details}}

Notes on patient status pre-discharge: {{form.Notes_on_patient_status}}

Medication prescribed post-discharge: {{form.Medication_prescribed_post-discharge}}

Doctor assigned for follow-up: {{form.Doctor_assigned_for_follow-up}}

Date of 48 hour follow-up call: {{form.48_hour_follow-up_call_date}}

Perform 1 week follow-up appointment

Patient name: {{form.Patient_name}}

Patient ID: {{form.Patient_ID}}

Patient birth date: {{form.Patient_birth_date}}

Patient details: {{form.Patient_details}}

Notes on patient status pre-discharge: {{form.Notes_on_patient_status}}

Medication prescribed post-discharge: {{form.Medication_prescribed_post-discharge}}

Doctor assigned for follow-up: {{form.Doctor_assigned_for_follow-up}}

48 hour follow-up call notes: {{form.48_hour_follow-up_notes}}

Date of 1 week follow-up appointment: {{form.1_week_follow-up_appointment_date}}

Perform 2 week follow-up appointment

Patient name: {{form.Patient_name}}

Patient ID: {{form.Patient_ID}}

Patient birth date: {{form.Patient_birth_date}}

Patient details: {{form.Patient_details}}

Notes on patient status pre-discharge: {{form.Notes_on_patient_status}}

Medication prescribed post-discharge: {{form.Medication_prescribed_post-discharge}}

Doctor assigned for follow-up: {{form.Doctor_assigned_for_follow-up}}

48 hour follow-up call notes: {{form.48_hour_follow-up_notes}}

1 week follow-up appointment notes: {{form.1_week_follow-up_appointment_notes}}

Date of 2 week follow-up appointment: {{form.1_week_follow-up_appointment_date}}

Perform 1 month follow-up appointment

Patient name: {{form.Patient_name}}

Patient ID: {{form.Patient_ID}}

Patient birth date: {{form.Patient_birth_date}}

Patient details: {{form.Patient_details}}

Notes on patient status pre-discharge: {{form.Notes_on_patient_status}}

Medication prescribed post-discharge: {{form.Medication_prescribed_post-discharge}}

Doctor assigned for follow-up: {{form.Doctor_assigned_for_follow-up}}

48 hour follow-up call notes: {{form.48_hour_follow-up_notes}}

1 week follow-up appointment notes: {{form.1_week_follow-up_appointment_notes}}

2 week follow-up appointment notes: {{form.2_week_follow-up_appointment_notes}}

Date of 1 month follow-up appointment: {{form.1_month_follow-up_appointment_date}}

Perform 3 month follow-up call

Patient name: {{form.Patient_name}}

Patient ID: {{form.Patient_ID}}

Patient birth date: {{form.Patient_birth_date}}

Patient details: {{form.Patient_details}}

Notes on patient status pre-discharge: {{form.Notes_on_patient_status}}

Medication prescribed post-discharge: {{form.Medication_prescribed_post-discharge}}

Doctor assigned for follow-up: {{form.Doctor_assigned_for_follow-up}}

48 hour follow-up call notes: {{form.48_hour_follow-up_notes}}

1 week follow-up appointment notes: {{form.1_week_follow-up_appointment_notes}}

2 week follow-up appointment notes: {{form.2_week_follow-up_appointment_notes}}

1 month follow-up appointment notes: {{form.1_month_follow-up_appointment_notes}}

Date of 3 month follow-up call: {{form.3_month_follow-up_call_date}}

Perform 6 month follow-up call

Patient name: {{form.Patient_name}}

Patient ID: {{form.Patient_ID}}

Patient birth date: {{form.Patient_birth_date}}

Patient details: {{form.Patient_details}}

Notes on patient status pre-discharge: {{form.Notes_on_patient_status}}

Medication prescribed post-discharge: {{form.Medication_prescribed_post-discharge}}

Doctor assigned for follow-up: {{form.Doctor_assigned_for_follow-up}}

48 hour follow-up call notes: {{form.48_hour_follow-up_notes}}

1 week follow-up appointment notes: {{form.1_week_follow-up_appointment_notes}}

2 week follow-up appointment notes: {{form.2_week_follow-up_appointment_notes}}

1 month follow-up appointment notes: {{form.1_month_follow-up_appointment_notes}}

3 month follow-up call notes: {{form.3_month_follow-up_call_notes}}

Date of 6 month follow-up call: {{form.6_month_follow-up_call_date}}

Patient tests positive for C0VID-19 post-discharge:

Follow re-isolation procedures

Strict discharge standards have been implemented in our hospital. There is no discharged case in our hospital whose sputum and stool samples are tested positive again in our follow-ups.

However, there are some reported cases that patients are tested positive again, after being discharged based on the standards of national guidelines (negative results from at least 2 consecutive throat swabs collected at an interval of 24 hours; body temperature remaining normal for 3 days, symptoms significantly improved; obvious absorption of inflammation on lung images).

It is mainly due to sample collection errors and false negative testing results. For these patients, the following strategies are recommended:

  • 1
    Isolation according to the standards for C0VID-19 patients
  • 2
    Continuing to provide antiviral treatment which has been proved to be effective during prior hospitalization
  • 3
    Discharge only when improvement is observed on lung imaging and the sputum and stool are tested negative for 3 consecutive times (with an interval of 24 hours)
  • 4
    Home isolation and follow-up visits after discharge in accordance with the requirements mentioned above

Sources:

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