Escalating care

Patients, other household members and caregivers should be advised to contact the patient’s GP or hospital-led service via telephone for advice if symptoms worsen or there are any red flag symptoms (refer to Box 3). It would be helpful to give patients written information about symptoms to watch out for. If the GP is not immediately available, they must call emergency services on 000 and clearly communicate the patient’s COVID-19 status to the phone operator. The ambulance crew must be aware of the patient’s COVID-19 status and will relay this to the receiving emergency department.

Transfer to hospital is recommended if the patient develops symptoms or signs suggestive of moderate or severe COVID-19, such as:

• SpO2 less than or equal to 92%, even if feeling well
• worsening shortness of breath or difficulty breathing
• blue lips or face
• pain or pressure in the chest
• cold and clammy, or pale and mottled skin
• confusion or fainting
• becoming difficult to rouse
• little or no urine output
• coughing up blood.⁵

If a patient with minimal or mild symptoms shows signs of deterioration, particularly breathlessness, without the above signs:

• ensure they have an action plan in case of rapid deterioration
• increase the frequency of surveillance
• consider referral to a hospital-led COVID-19 service.

When patients are being cared for in the community by GPs, GPs, the patient and the patient’s family/supports can escalate care to ambulance or hospital if they have any concerns, regardless of whether they meet the criteria outlined above.