Managing patients who present with respiratory symptoms
Preparation
Establish a room that allows you to isolate patients presenting with respiratory symptoms if they require a face-to face consultation. You can prepare this room as per the RACGP COVID-19 infection-control principles.
If this is not possible, arrange a suitable waiting area located near the practice, such as the courtyard or car park. This space should be isolated and located a safe distance from the clinic’s main entrance.
Note: Regularly re-visit your practice layout and patient flow plans. Where possible and appropriate, you can use strategies listed within the RACGP’s
COVID Safety Plan template to assist in maintaining a safe and efficient workplace.
Screening
An initial screening/triaging consultation for all patients is recommended. This can be performed when a patient books an appointment via phone or by including a questionnaire/declaration on your online booking platform. This process (if via phone) can be performed by a non-clinical staff member. However, where there is any uncertainty or concern regarding the health status of a patient during this process, clear protocols must be in place which allow escalation of these cases to clinical team members such as practice nurses.
Patients with respiratory and related viral symptoms should be advised they must not enter the practice until suitable precautions are put in place.
Screening should include:
- the date and nature of the onset symptoms
- the noting of any key symptoms – fever, sore throat, shortness of breath, dry cough, muscle aches and/or tiredness, loss of taste, loss of smell (other symptoms include headache, runny nose, sneezing, diarrhoea and/or nausea)
- whether the person has undergone testing for COVID-19, influenza or another respiratory disease
- whether the person has had any close contact with a confirmed case of COVID-19 or influenza.
If a patient with symptoms arrives at your practice without notice, proceed to ‘Triage.’
Triage
All patients with respiratory symptoms should be tested for COVID-19. If this is your patient’s first contact with a healthcare provider in relation to respiratory tract infection symptoms or contact with COVID-19:
- Ensure they are tested for COVID-19 (RAT [home or point-of-care] or PCR) at the same time as ensuring any urgent clinical needs are addressed.
- Confirm if the patient has undertaken a RAT or PCR test in the previous 24 hours and the result.
- Make a clinical assessment as to whether testing is required at this time.
- Determine if a telehealth or face-to-face consultation is most appropriate.
If the patient attends your practice for a face-to-face consultation, ensure appropriate infection prevention control measures are in place, including adequate ventilation and the appropriate use of PPE for the patient and the general practice team.
Patients with respiratory symptoms should (at a minimum) always wear a surgical mask whilst in the practice and during any face-to-face consultation.
If a RAT result is negative, the patient should be encouraged to repeat a RAT on subsequent days if they remain symptomatic.
Note: If the patient is assessed to have moderate or severe symptoms suggestive of pneumonia, it may be appropriate to refer them to the local GP-led respiratory clinic or hospital for review and testing. Following the closure of federally funded GP led respiratory clinics, some states have set up their own systems within primary health for dealing with respiratory illnesses. Please check your local health department or local
HealthPathways for further information.
Preparing for assessment and testing
Ensure that your practice’s dedicated consultation room is decluttered, isolated (if possible), well ventilated, and has a strip of tape on the floor positioned 1.5 m from the consulting chair and desk to facilitate physical distancing during the consultation.
Before entering the room, perform hand hygiene and don appropriate PPE as determined by risk assessment:
Likely low risk of SARS-CoV-2 transmission – use PPE in accordance with existing guidance for standard, contact and droplet precautions, as specified in the Australian guidelines for the prevention and control of infection in healthcare (2021). This includes wearing a surgical mask and protective eyewear.
Due to the continued high prevalence of COVID-19 in Australia and surges of other respiratory illnesses with no reliable way to differentiate between viruses based on symptoms alone, appropriate precautions should be applied to all respiratory and gastrointestinal illnesses.
Likely high risk of SARS-CoV-2 transmission – use P2/N95 respirators, rather than surgical masks, along with other required PPE as specified in the Australian guidelines for the prevention and control of infection in healthcare (2021).
Note: In some situations, consultations may take place in outdoor areas such as a practice car park. Maintaining patient privacy remains crucial in all settings. When consulting with patients in public facing spaces (i.e., a car park), please be mindful of surroundings.
After assessment and testing
Remove PPE, performing hand hygiene between every step of the process and again after all PPE has been removed.
Don fresh, non-contaminated gloves, a surgical mask and eye protection in preparation to clean the room. Wipe down any touched surfaces (e.g. door handles, desktops, stethoscopes and otoscopes) using a cleaning detergent followed by a TGA approved disinfectant, or by using a two-in-one product with cleaning and disinfecting properties.
Further information on applying, removing and disposing of personal protective equipment can be found in the RACGP Infection prevention and control guidelines.
Once all surfaces have dried, the room is safe to be used for the next patient consultation.
Note: Depending on space available, your practice may ask some patients to wait in their car or a dedicated space within the practice grounds following their appointment for an observation period. In such situations, ensure that there is at least one practice staff member available to observe these patients and organise appropriate assistance where needed. The available staff member can be non-clinical, however, protocols should be in place for where escalation of care is required.
Billing
Patients who were initially screened via phone or video consultation and were subsequently required to visit the practice for a face-to-face attendance on the same day are considered to have taken part in a single, extended consultation for Medicare purposes and should be billed accordingly. The time of each of these consultations should be documented to assist in the assessment of applicable benefits.
However, you can bill multiple attendances for the same patient on the same day if:
- they are separate attendances with a reasonable lapse of time between them AND
- the subsequent attendances are for a new/different clinical scenario.
For patients who were not initially screened via phone or video consultation, proceed with standard billing.