Hospital-in-the-Home during the COVID-19 pandemic
The COVID-19 pandemic is affecting much about the way we deliver healthcare, except that our patients remain our priority. Our ability to treat children at home is now more important than ever, both to care for them in the place that they are most comfortable and to free up hospital beds for sicker children.
We are fortunate at The Royal Children's Hospital (RCH) that we have a large established Hospital-in-the-Home program (called Wallaby Ward) and we are experienced in looking after acutely unwell children at home. We will provide care for patients without COVID-19, even if they are being isolated, and for patients with suspected or confirmed COVID-19. We are continuing with our strong hand hygiene practices and where possible the physical distancing recommendations.
For referrers with patients with COVID-19
We accept referrals from doctors, nurses and allied health colleagues in hospital and in the community. For the large majority of children, COVID-19 is a mild illness without the need for specialist healthcare input, especially with the omicron variant. These children can be cared for by their parents with the support of their GP as needed. A few children will be severely unwell and need admission to hospital (see Clinical Practice Guideline for COVID-19). Wallaby Ward cares for children in between and this can be considered via our traffic light guideline for omicron, in summary:
Refer to hospital - SEVERE SYMPTOMS: children with difficulty breathing and needing oxygen; with dehydration needing IV or NG fluids;
with PIMS-TS; with complications eg pulmonary embolism
Refer to HITH - REQUIRING HOSPITAL BED REPLACEMENT
1) Persistent increased work of breathing (fast/using accessory muscles) but maintaining oxygen sats >92% in air
2) Selected high-risk co-morbidities (Trisomy 21, extreme obesity, immunosuppression) & mildly increased work of breathing
3) Transition to home after inpatient admission
Parent/GP care - ASYMPTOMATIC OR MILD SYMPTOMS: most co-morbidities (asthma, congenital heart disease, mild-moderate
immunosuppression, chronic lung disease, neurodisability) when there are mild symptoms only, including fever, cough,
decreased drinking
If needing to refer, please review the omicron traffic light guideline, and then complete this referral form (PDF) or this version (Word) AND call us on 03 93454770.
For patients without COVID-19 during the pandemic
We provide face-to-face care for children where this is needed and are increasing our use of telehealth where this is an option.
For patients with suspected or confirmed COVID-19
We provide daily telehealth assessments and reviews, with face-to-face care and additional testing as necessary. We will wear the appropriate personal protective equipment for each individual child that we visit.
For all families
Looking after yourselves as well as your children is important as this can be a very stressful time for families – medical stress, emotional stress, financial stress. Our social work team at the RCH has put together a tip sheet for families, and the Raising Children Network has good advice about talking to children about COVID-19.
For staff providing care to children in the home
Our front-line staff are the lifeblood of our service and their health and well-being are paramount. We are following departmental guidelines about case definitions and infection control and have provided clear guidelines about when staff need to wear which personal protective equipment (PPE). We have made easy-to-follow charts of how to don and doff PPE and take a swab for COVID-19 testing. Importantly, we are also looking after each other’s morale.
For staff developing resources for Hospital-in-the-Home
We have built on our 15 years of hospital-in-the-home experience to develop our own COVID-19 clinical resources and contribute to the national HITH Society resource for planning and clinical care for hospital-in-the-home during the COVID-19 pandemic. We continue to think of patients that we could treat at home to relieve pressure on hospital beds. We are also developing novel ways of improving our care for patients via telehealth, both with and without COVID-19.