MSH Assessment Centre
Dear OHT Primary Care Physicians,
Our Markham Stouffville Hospital colleagues have been working hard to put together a MSH COVID-19 assessment centre which opened today. Website here: https://www.msh.on.ca/about-us/covid-19-information-page#assessment
Location: South side of Markham Stouffville Hospital
Hours: 10 AM to 8 PM
Details: Walk-in only. Patients are triaged by a nurse first and either sent home, brought into the assessment centre or sent to ED. The centre has 6 exam rooms and a waiting area that can accommodate 10 people. It is staffed with 1 doctor and 2 RPNs who perform the swab if required. There is NO lab, x-ray or ECG capability. Supplemental O2 and a defribillator are present. If patients need further workup they will be referred to MSH ED for consultation. Documentation is electronic on the hospital system (Meditech). Doctors will need MSH hospital privileges and Meditech access to work at the clinic. There are two 5 hour shifts per day. The physician payment will flow through the hospital at $250/hr.
If you are interested in helping at the assessment centre, please email Trevor Whyte (trwhyte@msh.on.ca) and Dr. Wendy Iseman (wiseman@msh.on.ca). If you need MSH hospital privileges, please also copy Dr. Allan Grill (agrill@msh.on.ca) who can help expedite the process.
Other nearby assessment centres: Mackenzie Health requires referral. More information and physician referral form can be found at https://www.mackenziehealth.ca/en/about-us/get-the-latest-information-on-covid-19.aspx. Scarborough Health Network – Birchmount Hospital, that is self-referral with an online preregistration form. https://www.shn.ca/covid19-assess/
WHO DO I SEND TO AN ASSESSMENT CENTRE?
There is a fundamental shift in who we are testing, with more focus on 2 priority groups 1) those at risk of spreading disease into vulnerable populations (patients/workers in healthcare settings, shelters, prisons & other vulnerable social populations) and 2) those at risk of severe illness (elderly, comorbidities). Note travel is not a criteria for sending a patient to an assessment centre. It is still a question the assessment centre will ask for case finding.
I've attached the MSH Assessment Centre Triage Criteria which was developed by the GTA hospital ID/IPAC physicians in absence of MOH guidance and is being used at other assessment centres. The quick summary is...
Do NOT send if asymptomatic
If Mild symptoms advise to self-isolate and monitor for worsening of symptoms
If Severe symptoms, increased shortness of breath, lethargy or chest pain then send to ED.
Send to assessment centre if a patient has mild to moderate symptoms of fever and/or respiratory symptoms PLUS one of
- underlying health condition (diabetes, heart/lung disease, cancer, immunocompromised)*
- age > 60*
- health care worker
- vulnerable population
* For our elderly patients and those with comorbidities, we should use our clinical judgement. If mild symptoms then they may be better to stay home and monitor with instructions on what to do if symptoms worsen.
For all other patients with mild respiratory illness, they should self-isolate until completely symptom free for 48 hours. Guide for self-isolation for patients and caregiver/household members is available on the public health website at: https://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novel-coronavirus/public-resources. I've also attached a good public health handout on the difference between self-monitoring, self-isolation and isolation.
Please tell patients not everyone we send to the assessment centre gets swabbed. Even if they appear to meet criteria. Turnaround time is currently around 5 days for swab result.
Lastly, please stay safe! In reviewing Public Health and OMA guidance, and confirmed with Occupational Health at MSH any patient with acute respiratory symptoms that needs assessment should only be assessed by a provider who is wearing FULL PPE (gown/mask/goggles/gloves) and knows how to doff and don. I believe that means that most of us cannot safely assess our patients with acute respiratory illness in clinic, thus we will have to make phone assessments and use clinical judgement on if we can safely keep these people at home versus needing to attend an assessment centre (remember think high risk population for spread or risk of severe illness) or to ED if severe symptoms.
If you've made it this far, thank you for reading. Please distribute widely to your primary care colleagues in our area who are not linked to the OHT yet. As always, happy to hear any questions or concerns.