Week April 27-May 1, 2020

PractitionerVirtual Q&A

COVID-19

Topics to be covered:

1. Weekly Physician Wellness Boost & Training Opportunity2. Daily Dashboard & Public Health Orders3. Planning for Service Resumption While Maintaining our

Offensive4. New Clinical Orders/Updates5. System Flow Coordination Centre Launch6. SMA Update7. Pandemic Physician Agreement Update8. CPSS Update 9. Physician Information & Communication10.Questions & Answers

Weekly Physician Wellness Boost

Weekly Physician Wellness Boost

Strategies for Anxiety During COVID-19 – Dr. Helen Lowry

Strategies for Anxiety During COVID-19: Preview / Full(available on the physician wellness and support page)

Physician Wellness Support Contacts:

Saskatoon, NE, NW: Brenda Senger

306-657-4553

Regina, SE/SW: Jessica Richardson

306- 359-2750

Saskatchewan Medical Association Physician Health Program

Strengthening capacity –now and into the future

Peer Support Training(Annex T: Mental Health and Psychosocial Supports)

Peer Support Training – Why is it helpful?

• Traumatic stress can have physical, emotional, cognitive, and behavioral signs and symptoms

• Acute critical incident stress and/or cumulative, repetitive occupational exposure

• Peer support done in partnership with mental health professionals to access specialized support when needed

• Accessed via the Physician Health Program with the SMA or Mental Health Support line for HCWs (coming next week)

Peer Support Training - Information

One-day (8:30-4:30)

Webex Training Dates:

Tuesday, April 28Thursday, April 30

Tuesday, May 5Thursday, May 7

More to come…

If interested, apply atSHA Psychosocial Support Network:

COVID19.psychosocialsupport@saskhealthauthority.ca

Training registration sent directly to you

Please note: This is not a CISM-certified course. Content has been

modified to meet the virtual learning environment and the current context.

Objective: To learn more about crisis intervention skills and how best to provide peer support to colleagues.

Daily Dashboard and Public Health Orders

Daily Dashboard(April 27, 2020)

As of April 27, there are 12 new

confirmed cases, bringing the total to 365 reported cases

of COVID-19 in Saskatchewan.

Effective Reproductive Rate (Rt)

The SHA is releasing a new data point, effective reproductive rate to help in evaluating Saskatchewan’s performance on combatting COVID-19. Saskatchewan’s R0 (pronounced R-naught) value is 3.12, meaning that with no intervention, for every one (1) person infected, the virus will spread to 3.12 others.

As of April 25, the Effective Reproductive Rate (Rt value) in

Saskatchewan is 0.7. This needs to stay consistently below 1.0 to support

relaxed restrictions

Rt, is the average number of people each COVID+ person in our province is infecting.

R₀, is the approximate number of people that an infected person would infect over the course of their illness if there were ZERO INTERVENTIONS IN PLACE and everyone around them was susceptible. It is proportional to the duration of the infectious period, the probability of infecting a susceptible individual during one contact, and the number of new susceptible individuals contacted per unit of time.

Public Health Order Restricting travel to and from Northern Sask (April 24, 2020)

Effective April 24, 2020, no person shall travel to or out of the Northern Saskatchewan Administration District [NSAD], whether from within the Province of Saskatchewan or otherwise, except as follows:

i. Persons whose primary residence is in the NSAD;ii. Employees of, and persons delivering, critical public services and allowable business servicesiii. Aboriginal persons engaging in activities such as exercising their constitutionally protected right to hunt, fish and trap for food or engaged in other traditional uses of lands such as gathering plants for food and medicinal purposes or carrying out ceremonial and spiritual observances and practices; and,iv. Persons who travel to or out of the NSAD for medical treatment.

Planning for Service Resumption While Controlling Risk

Government of Saskatchewan Re-open PlanThe Big Picture

https://www.saskatchewan.ca/government/health-care-administration-and-provider-resources/treatment-procedures-and-guidelines/emerging-public-health-issues/2019-novel-coronavirus/re-open-saskatchewan-plan/phases-of-re-open-saskatchewan

The Planning Process Has Begun, Implementation is yet to come…

• Planning has commenced to determine a service resumption plan to align activation of services with:

• SHA strategic objectives • In the context of the impact on patient population, the impact on wait

times (including morbidity and mortality), and • Capacity and resources.

• Integral to the re-open plan, the SHA has already implemented several initiatives (such as testing and assessment sites, outbreak management in long-term care, etc.) to support care in community to:

• Reduce the burden on the acute care system • Promote faster recovery from illness • Prevent unnecessary / premature admissions to acute / long-term care• Support timely discharge from hospital, and • Maximize independent living.

Planning Will Remain Rooted in our Strategic Goals…

Connected Care Safety Physician Leadership

System-wide Integration

• Improve team-based care in the community

• Improve access to mental health & addiction services

• Enhance team-based care in the hospital and ensure seamless patient care at all points in the health system

Health Networks: wrapping services around patients

The Big PictureControlling Risk

The Government of Saskatchewan noted that as restrictions are gradually lifted, the Government of Saskatchewan and its Chief Medical Health Officer, Dr. Saqib Shahab, will carefully monitor the daily number of reported cases and other important indicators. They will also monitor to ensure that:• Transmission of the virus is controlled;

• The provincial health system has enough capacity to test, isolate and treat every case, as well as trace every contact;

• Outbreak risks are minimized in special settings, such as health care facilities; • Preventive measures are established in place in workplaces, schools and other

essential gathering places;

• The risks of importing the virus from outside the province can be managed; and• Communities and businesses are educated, engaged and empowered to adjust

to the new realities brought about by COVID-19.

Information is Our Best Defense (and Offence!)

2. Increase Testing• Work is in progress to scale up testing to ensure critical monitoring and

evaluating each phase of the “Re-open Saskatchewan” plan.

3. Rigorous Contact Tracing• New go.Data app made available by the

World Health Organization to centralized contact tracing in order to respond to surges in the number of COVID 19 positive cases

1. Gauging the Effective Reproductive Rate (Rt)• New weekly reports to show how effective

current interventions are (needs to stay consistently below 1.0 to support relaxed restrictions).

4. Protection of our most vulnerable• Continued elevated measures for vulnerable and marginalized populations

including long-term care and vulnerable areas.

5. Monitoring our supplies• Re-opening public health measures will have an impact on PPE – close

monitoring of supplies will continue and reported via PPE bulletins/updates.

6. Readying our workforce to respond as needed• Numerous efforts have been implemented to support a flexible workforce

that meets the needs of patients – this work will continue to provide the flexibility needed as we transition.

7. Patient Voice• continue to partner with patients and families to ensure that patient and

family perspectives are incorporated into our response.

Information is Our Best Defense (and Offence!)

New Clinical Orders/Updates

The latest Rapid PPE Updates

April 23: https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-providers/ppe/ppe-rapid-update-agmp-settle-time-final.pdf

April 23: https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-providers/ppe/ppe-rapid-update-is-coughing-an-agmp-final.pdf

AGMP Settle Time

Is Coughing an AGMP?

For the latest updates visit

www.saskatchewan.ca/covid-19

as these PPE updates get added

frequently

Updated AGMP List(April 22)

Further consultation with stakeholders and review of existing evidence has resulted in Oxygen delivered as more than 6L by nasal prongs, venture masks, HiOx masks has been moved from the unclear AGMP column to a NON-AGMP. This move aligns practices with other front-line groups such as STARS and allows for smoother patient flow. The non-AGMP position is supported by evidence presented in a recent European Respiratory Society review of the topic and aligns with other jurisdictions.

https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-providers/ppe/sha-covid19-aerosol-generating-medical-procedures-list-and-risk-stratification-algorithm.pdf

Laboratory Medicine - Microbiology Testing Remains Limited

• Laboratory Medicine has been working to increase testing capacity for COVID-19 throughout the province. Goal = 1500 COVID tests/day. This work is not completed but it is now at a state of controlled implementation with solid project plans in place which will be monitored daily.

• Based on this plan, your support and understanding is requested to continue to limit routine laboratory testing, based on your clinical judgement, to ensure we can maintain a strong base of laboratory services for both COVID and NON-COVID patients.

(April 25, 2020)

https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-providers/testing-screening-and-medical-directives/laboratory-bulletin-limited-test-menu-april-25-2020.pdf

General Updates…

New Work Standard developed to outline the process for placement of patients who meet criteria for placement of Droplet and Contact Plus Precautions as well as discontinuing precautions for COVID-19 negative patients. https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-providers/testing-screening-

and-medical-directives/screening/cv-19-ws0010-placement-and-discontinuing-on-covid-19-precautions-april-24-2020.pdf

Staff and physicians have been adding additional pieces of PPE to the recommended precautions, such as hair or shoe covers. Based on best practice and clinical evidence, there is no additional benefit with respect to reducing disease transmission beyond standard infection control practices already in place. Adding additional pieces of PPE beyond those recommended may result in harm by increasing risk of self-contamination during the doffing process. https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-providers/ppe/3-ppe-bulletin-april24-final.pdf

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General Updates Continued…

Antepartum Care Standard for COVID-19: https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-providers/clinical-pratice-resources/maternal-childrens-health/cv-19-ws0020-antepartum-care-standard-for-covid-19.pdf

Postpartum and Newborn Care Standard for COVID-19: CV-19 WS0019 Postpartum and Newborn Care Standard for COVID-19

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Three NEW Work Standards to reduce and contain the spread of influenza-like illness (ILI) (such as COVID-19) while supporting the direct and unique needs of maternal and child populations. These work standards outline how best to protect patients and health care providers through the responsible evidence-based utilization of personal protective equipment (PPE) and provides principles to guide the practice within Saskatchewan, each clinical program/unit will be required to adopt the principles into established and monitored local plans and practices.

Intrapartum Care Standard for COVID-19: https://www.saskatchewan.ca/-/media/files/coronavirus/info-for-health-care-providers/clinical-pratice-resources/maternal-childrens-health/cv-19-ws0021-intrapartum-care-guidelines-for-covid-19.pdf

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Starting 29 April 2020: System Flow Coordination Centre

What is the System Flow Coordination Center?

Single Provincial Access line to access:• Physician to Physician connections for Urgent / Semi

Urgent Consults and Admissions for all Acute Hospitals in the Province

• Admission and Bed Placement Support that provides “traffic control” for patients to access acute care beds that meet their needs as close to home as possible

1-866-766-6050

What does this mean for Physicians?

When you previously would call ACAL or Bedline – you will now call the SFCC at 1-866-766-6050

• NOTE: services don’t change, but the phone prompts change

NEW: similar service provided by ACAL and Bedline will now connect to Northern and Rural (South) physicians and hospital admissions.

ACAL and Bedline Phone Prompts will change:

• ACAL Calls will be directed to the SFCC phone lines

• New SFCC number is the same as Bedline old number but will have new prompts.

How are we organized?

• One Provincial Number:

1-866-766-6050Phone Prompts:1 - Critical Care and Trauma2 - Regina and Saskatoon Specialist Support3 - Rural South Specialist Support and bed placement 4 - North Specialist Support and bed placement5 - Regina Hospital Bed Placement or a Utilization Coordinator6 - Saskatoon Hospital Bed Placement7 - LINK non-urgent physician consults

ACAL Prompts SFCC Prompts: 306-655-8008: 1-866-766-6050

1. Critically ill patients or major trauma-Press 1

2. To reach patient placement for admissions and bed availability-Press 2

3. To be directed to a Saskatoon consultant or a LINK physician-Press 3

4. If you are a consultant calling in-Press 4

5. If you have a non-urgent consult that can wait 30 min and you wish to leave a voicemail-Press 0

1. Critically ill patients or major trauma2. Regina & Saskatoon Specialist Support

3. Rural South Specialist Support and Bed Placement

4. North Specialist Support and Bed Placement 5. Regina Admissions or Bed Placement

6. Saskatoon Admissions or Bed Placement:1. Admissions from Emergency Department

only2. For City or St. Paul’s Hospitals3. For RUH or JPCH

7. LINK non-Urgent Consult programIf you call the ACAL number (306-655-8008) the phones will auto direct you to the SFCC phone line and prompts and connect you to the SFCC team

LINK – Connects Primary Care Providers and Specialists

1-844-855-LINK (5465)• Existing phone consult service between primary care providers

and specialists. (Mon-Fri: 0800-1700)• Helps avoid unnecessary referrals and reduce travel and costs for rural

patients• Specialties provided:

• Urology (new), Adult Psychiatry, Child Psychiatry, HIV and HCV, Nephrology, Obstetrics and Gynecology, Palliative Care, and Reproductive Endocrinology and Infertility

• Also accessible via the SFCC – choose prompt #7

NOTE: No change to referral patterns • LINK is not intended to affect referral patterns. The specialist on call is not expecting

to receive direct referrals as a result of providing the LINK service. If a referral is warranted, primary care providers will follow their existing referral practice.

Leveraging Immediate Non-urgent Knowledge

Bedline Calls: SFCC Prompts: 1-866-766-6050

Bedline Physician Access Line: 1-866-766-6050

Bedline Bed Placement Line: 306-766-6075

Bedline Utilization Coordinator Line: 306-766-6065

1. Critically ill patients or major trauma2. Regina & Saskatoon Specialist Support

3. Rural South Specialist Support and Bed Placement

4. North Specialist Support and Bed Placement 5. Regina Admissions or Bed Placement

1. Regina General Hospital2. Pasqua Hospital3. Utilization Coordinator Supervisor

6. Saskatoon Admissions or Bed Placement:7. LINK non-Urgent Consult program

Rural (South) and North SFCC Prompts: 1-866-766-6050

1. Used to access critical care and transport support for unstable patients (access to all provincial critical care)

3. Access to urgent/semi-urgent consults or patient admissions/transfers with Integrated Rural (South) physicians or hospitals. Also supports rural admissions and bed assignment• For Rural South physicians – you can use this prompt to “call

SFCC Back” if you missed their call to you. Coordinates Continuing Care Intermediate and LTC bed placement

4. Access to urgent/semi-urgent consults or patient admissions/transfers with Integrated Northern physicians or hospitals. Also supports rural admissions and bed assignment• For Northern physicians – you can use this prompt to “call

SFCC Back” if you missed their call to you.

1. Critically ill patients or major trauma2. Regina & Saskatoon Specialist Support

3. Rural South Specialist Support and Bed Placement1. Acute Care2. Continuing Care

4. North Specialist Support and Bed Placement

3. Regina Admissions or Bed Placement4. Saskatoon Admissions or Bed Placement5. LINK non-Urgent Consult program

When do you call the Provincial SFCC?

•When you need urgent or semi-urgent specialist consult

•to arrange an Acute admission in another hospital (i.e. transfers)

•When you want a direct admit to your home hospital (e.g. from your office, clinics etc.)

•Admissions for your own hospital (e.g. from the ED)• (you or your staff can call these in)

1-866-766-6050

Supporting Communication Materials

•Materials Available via SHA rounds and the COVID Website – All Physicians – High Importance section:

•Memo – includes a workflow diagram•Frequently Asked Questions – also includes detail summary of the phone prompts

•SFCC Poster•Copy of these Slides

SMA

SMA Update (as of April 27, 2020)

“Those who say it can’t be done, should not interrupt the ones doing it.”

Please do not hesitate to reach out to the Physician Health ProgramBrenda Senger (Saskatoon/North)306-657-4553

Jessica Richardson (Regina/South)306-359-2750

Pan-Canadian Peer Support too!

SMA Update (as of April 27, 2020)

• Compensation Policy• Pandemic Physician Services Agreement - work between SMA/SHA on

unique situations continues – impacts approximately 200 physicians• Continued advocacy on virtual care code improvements / expansion.

Physicians are also encouraged to contact the Medical Services Branch at the Ministry of Health directly

• Self-Isolation Benefit. Check out Practice Alerts for more information

• PPE• Online PPE Supplies Order Form available soon for all private,

community-based practices (family physicians and specialists). Please look to upcoming Practice Alerts for more information.

• General inquiries? sma@sma.sk.ca

Pandemic Physician Services Agreement Update

Pandemic Physician Services Agreement Update

Agreement specifics:

Total requested – 1226

Total fully executed/ pending physician signature - 901

Total to be executed – 319

Declined or did not qualify - 6

Contract questions – contract@saskdocs.caor call 306-933-5000

CPSS

CPSS Update

• General discussion points on the Re-Open Saskatchewan Plan and how it will affect physicians.

• The College is available for assistance, questions or concerns – Contact Us on our website.

Where do I find information?

Physician Communication –Next Steps

• Physician specific section on website: www.Saskatchewan.ca/covid-19NEW Search Function Launched last week!

• Regular Physician Virtual Town Halls –provincial summaries posted on the website each week!

• SHA daily rounds emails

@SaskHealthAuthority

@SaskHealth

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