Caring for Transgender and Gender Diverse Youth
Saturday, June 6. Save the date and check back for details.
Grand Rounds
Provider Grand Rounds: full schedule and Webex/dial-in information
May 7, 2020: Neonatal Cholestasis: More Than Yellow Eyes and Pale Stools. Niviann Blondet, MD; acting assistant professor of Pediatrics, UW; Gastroenterology, Seattle Children’s.
May 14, 2020: Improving the EHR to Support Clinical Decision-Making and Reduce Clinician Burnout. Ari Pollack, MD, MSIM; assistant professor, Pediatrics, UW; Nephrology, Prenatal Diagnosis and Treatment, Seattle Children’s. Read full post »
Guidance on When to Obtain a Second Test for SARS-CoV2
Guidance on who should be tested for SARS-CoV-2 has been updated to include information on when providers should consider sending a second test from patients who have had one test that is negative. Generally speaking, a second test should be reserved for patients for whom there is a high level of concern for COVID-19.
Rationale for obtaining a 2nd testing during a course of illness:
- Well-designed PCR tests for SARS-CoV2 have high analytical sensitivity, but clinical sensitivity is unknown due to lack of clinical gold standard.
- Clinical sensitivity is dependent on where the patient is in the course of their illness and the associated viral load (viral load decreases later in the course of illness).
- SARS-CoV2 appears to have anatomical tropism. For instance, in general, shedding persists for longer in lower respiratory tract specimens and as a result, lower respiratory tract specimens have higher sensitivity than upper respiratory tract specimens.
- Our testing strategy at Seattle Children’s calls for utilizing upper respiratory tract specimens as the primary specimen because it is not always possible and is often not easy to obtain a lower tract specimen from a pediatric patient.
- However, when suspicion for SARS-CoV2 disease (COVID-19) is high, consideration should be given to obtaining a second test and preferably from the lower respiratory tract if possible.
Read full post »
A multidisciplinary group of physicians at Seattle Children’s has developed a management guideline for patients with SARS-CoV-2 infection. Although there is no treatment with proven efficacy for COVID-19, this guidance will help with risk stratification and outlines evaluation and treatment approaches that should be considered. Current evidence for various investigational agents is also included. This guidance was developed with resources and capabilities at Seattle Children’s in mind. It will be updated periodically as more evidence becomes available.
The guidelines are currently being used by a multidisciplinary group at Seattle Children’s who review and discuss each patient before making recommendations based on current guidelines. These are general guidelines; as with most guidelines, clinical correlation is required. Read full post »
For a summary of Seattle Children’s news and information about COVID-19, read our Provider FAQs.
1. COVID-19 in Kids: Seattle Children’s Testing Shows 1.5% Positivity Rate
Seattle Children’s has tested 1,757 patients as of April 15, with 19 patients testing positive and 7 inconclusive, for an overall positivity rate of 1.5%. Seventeen patients who tested positive are recovering at home, two are hospitalized.
COVID-19 cases in children make up less than 2% of reported cases in the U.S., according to the CDC’s Morbidity and Mortality Weekly Report (April 7, 2020).
2. COVID-19 Scheduling Triage Extended to June 30
The triage standards instituted by Seattle Children’s for scheduling have been extended to June 30. The standards provide a consistent approach to scheduling across all specialties and locations and will minimize our scheduling backlog once standard operations resume.
Please note, scheduling triage standards apply to both new and return appointments.
Tier 1: Patients who need to be seen in person by the provider before July 1
- Clinical situation that could be compromised by delay in care and requires physical examination to support clinical decision-making
Tier 2: Patients who can be seen with a telephone or telehealth visit — can be scheduled at any time.
- Follow up care where the physical exam is not essential to decision making
- Key physical exam or imaging findings may be obtained by other means (e.g., PACS, photos, etc.)
- Referrals/consults that can be assessed with a telephone or telehealth visit
Read full post »
Seattle Children’s is officially calling a close to the influenza season due to the significant drop-off in (non-COVID-19) respiratory viruses detected during the last two weeks of testing.
To help contain the spread of COVID-19 in our community, Seattle Children’s has canceled large group gatherings taking place at our facilities, including those with attendees from the community (e.g. CMEs, classes, conferences, PALS courses, etc.). Please check with event organizers if you have questions or need additional information. If you are registered for an event and it is moved to WebeEx only, event organizers will notify you.
Seattle Children’s infectious disease and emergency medicine experts will share their experiences from the front lines at the epicenter of the COVID-19 outbreak in the United States. Topics include epidemiology, clinical presentation, foreign data and lab testing availabilities; infection control issues including PPE shortages; institutional response to COVID including employee testing; emergency services preparation and care; and potential antivirals and upcoming treatment guidelines. This special Provider Grand Rounds session will conclude with a Q&A with the panel. Join in Thursday, March 26, 8 a.m. PT/11 a.m. ET. Read more. Read full post »
Clinical Pediatric Webinar This Week
Join us Thursday, March 26 for “COVID-19: The Seattle Children’s Experience” via Webex at 8 a.m. PST. More information is available here.
Additional COVID-19 Clinic Scheduling Guidelines
The following triage guidelines are being used by clinics to ensure a consistent approach to scheduling ambulatory patients during COVID-19. These will be used for patients who are currently scheduled, as well as new scheduling requests. The guidelines are intended to continue to provide needed care to patients, preserve PPE, and promote social distancing for our staff, providers, and community.
Due to the uncertain duration of this pandemic situation, these guidelines will be used for current and new appointment requests until May 1. This will avoid the need to reschedule patients, decrease a scheduling backlog and access constraints, and allow for appropriate prioritization once standard operations resume.
We will provide an update in early- to mid-April letting you know whether or not this will continue through June 1. Thank you for your patience and efforts to continue providing patient care in alternative ways when possible.
Tier 1: Patients who need to be seen in person by the provider within the next 6 weeks (until May 1).
- Clinical situation that could be compromised by delay in care and requires physical examination to support clinical decision-making
Tier 2: Patients who can be seen with a telephone or telehealth visit — can be scheduled at any time.
- Follow up care where the physical exam is not essential to decision making
- Key physical exam or imaging findings may be obtained by other means (e.g., PACS, photos, etc.)
- Referrals/consults that can be assessed with a telephone or telehealth visit
Tier 3: Patients who can be rescheduled or placed in the queue for scheduling when we resume normal business operations — can be placed in a queue to schedule an in-person visit at a later date.
- Patient condition does not suggest clinical urgency
- Family prefers an in-person visit
- Clinic does not have capacity to provide a telehealth or telemedicine visit
- Referral/consult cannot be assessed with a telephone or telehealth visit
Read full post »
We know this is a rapidly changing situation and we will continue to provide updated information about how Seattle Children’s is preparing and managing COVID-19, and how we can support primary care providers.
Are there any changes to Seattle Children’s outpatient radiology services?
We are continuing to offer a full range of imaging services including walk-in diagnostic outpatient x-ray in Bellevue, Federal Way, Everett, and Seattle. All families will be asked a series of screening questions before they enter the building. Families who present with respiratory symptoms or influenza-like illness will be put in strict isolation. We may consider less investigative studies when applicable.
When should PCPs send patients to Seattle Children’s Emergency Department (or not)?
Please only send your patients to Seattle Children’s Emergency Department if they are sufficiently ill to need emergent treatment (i.e. they meet criteria for being admitted). Please call our ED Communications Center first at 206-987-8899.
Patients with non-emergent respiratory symptoms and concern for COVID-19 should call Public Health – Seattle & King County and quarantine at home.
Who is being tested for COVID-19?
Current capacity for testing is limited. Ambulatory or admitted patients qualify for testing if they meet the current CDC definition of PUI, which currently (as of 3/4/20) includes relevant travel exposure, contact with a known COVID case, and those admitted with fever and lower respiratory tract infection. Results typically take between 24 to 48 hours.
Is Seattle Children’s able to test for COVID-19?
The viral respiratory panel used at Seattle Children’s does not detect COVID-19. We are sending our COVID-19 panels to the University of Washington for testing and receiving results back in 24-48 hours. Current capacity is limited.
COVID-19 testing is available only for our inpatients with respiratory symptoms and patients who meet the CDC testing criteria.
Additional Resources
If your patient has questions or is concerned about COVID-19, please refer to these resources from Washington State Department of Health:
For additional information to support families, see:
Read full post »
PCPs Play a Critical Role in Pandemic Response
Seattle Children’s anticipates a massive response will be required by healthcare providers on all fronts to respond to COVID-19. Hospitals, ERs and urgent cares will be strained to capacity to treat the sickest patients; their ability to keep up and save lives will depend in large part on primary care providers having capacity and resources to treat less acute patients throughout our communities.
What you can do:
- Prepare your clinics immediately to see low acuity respiratory patients.
- Divide your flow so that patients with and without respiratory symptoms are seen in separate spaces.
- Consider a front door v. back door check in process.
- Consider seeing symptomatic kids in their cars and/or asking them to remain in cars until a room is ready for them.
- Be creative in this crisis situation to minimize in-person patient visits for suspected COVID; use phones, video apps, etc. to see patients and help limit the spread of the virus.
- Do not automatically redirect patients with respiratory symptoms to urgent care or emergency departments. Manage as much patient care as possible without sending patients to urgent care or the ED.
- If you experience an increased demand for respiratory visits, consider canceling planned non-urgent patient visits, such as well-child care. Limit well-child appointments to immunizations only, to free up appointments for respiratory patients.
- Isolate non-emergent respiratory patients with quarantine at home.
- Consider coordinating with other clinics to become a larger outpatient system for triaging and managing patients.
- Focus now on procuring the personal protective equipment (PPE) needed by your staff, including gloves, masks, eye shields or goggles (not eyeglasses), and gowns.
- Stay up-to-date on the CDCs guidance on evaluating and reporting Persons Under Investigation (PUI).
Read full post »
