Provider FAQs – COVID-19

Updated March 31, 2020

Below you will find FAQs on the following:

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).
  • If families have questions about the coronavirus, please have them call Seattle Children’s only if their question relates specifically to an upcoming appointment with us. We are contacting patients and families whose clinic appointments must be postponed or changed to a different location or a phone visit.

Thank you for your partnership.

 

Information about Testing

Q: Who is being tested for COVID-19?

A: Seattle Children’s has updated its COVID-19 testing guidelines.

Seattle Children’s has updated its guidelines for testing pediatric patients for the coronavirus, in accordance with guidance from Public Health – Seattle & King County and uncertainty in the testing supply chain. We will continue to update our guidelines as the situation changes.

Seattle Children’s is now testing the following for COVID-19:

  • Admitted patients with any respiratory symptoms or fever of unclear etiology
  • ED/Urgent care/Ambulatory patients with:
    • Acute respiratory symptoms with or without fever AND who fall into ANY ONE of the following groups:
      • Other underlying medical conditions that place a patient at high risk for complications from a viral respiratory illness, such as immune compromised state, chronic cardiac conditions, chronic pulmonary conditions, diabetes, etc.
      • Patients frequently cared for at SCH and anticipated to have multiple visits at SCH in the following 2 weeks
      • Patients involved in an illness cluster in a care facility or institution (e.g., those who live in a long-term care facility)
  • Pre-BMT patients will be tested per SCCA protocol.
  • All pre-operative patients including patients who will have a procedure in an operating room and those who need anesthesia in Radiology. Pre-op tests need to be collected 48 to 72 hours prior to surgery or procedure. Outpatients who are scheduled for a procedure will be tested at our Sand Point Learning Center drive-through testing site. All testing is ordered by Seattle Children’s providers and is not open to the general public.

Seattle Children’s may test the following for COVID-19, but will exercise judgment in using tests judiciously to save testing kit availability. We will only test if the result will impact patient care; it is reasonable to consider these patients presumed COVID-19 positive without testing and manage per WA DOH recommendations:

  • ED/Urgent care/Ambulatory patients with mild acute respiratory symptoms with or without fever AND with one of the following:
    • International travel in the last 14 days
    • Prolonged close contact (<6 feet for more than a few minutes) with a known COVID-19 positive case

Seattle Children’s WILL NOT test the following groups (unless they are pre-operative):

  • Asymptomatic patients
  • Children who are not in high risk groups and who have mild disease

Q: What if my patient needs pre-operative COVID-19 testing but can’t get it done locally, or get it done at all?

A: Our Perioperative Services will be working with families traveling from further away to help coordinate early arrival to the Seattle area for testing (48 to 72 hours prior to surgery/procedure) at our Sand Point Learning Center (SPLC) location. Unfortunately, we lack capacity to offer testing at sites outside Seattle, including our regional clinics; all pre-operative testing will be offered at our SPLC location only.

We understand there will be patients who are unable to undergo testing prior to surgery due to distance or urgency of procedure.  If testing cannot be conducted, there will be a clinical escalation to decide if the procedure should:

    • Be postponed until patient has recovered (if symptoms exist)
    • Be postponed until testing can be completed
    • Proceed – with appropriate precautions in place to protect our workforce

As a reminder, Seattle Children’s is informing families of the pre-op testing requirement, placing the screening order at SPLC and communicating the test results. All testing is ordered by Seattle Children’s providers and is not open to the general public.

Q: Is Seattle Children’s able to test for COVID-19?

A: 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.

Q: How will I know if you are treating my patient for COVID-19?

A: If your patient is seen at Seattle Children’s for suspected COVID-19 (or any other condition), you will receive our standard fax communications regarding ER summary, admission, discharge etc.

Q: Will you notify PCPs of their patients’ coronavirus test results?

A: Yes, PCPs will receive notification from Seattle Children’s of their patient’s test result, regardless of whether it is positive or negative. In the latter instance PCPs can expect to receive a copy of our standard lab report via fax. (Please note: inconclusive results are being treated as “positive” until confirmed by the State or CDC.)

We are also providing test results to families and directing them to contact their child’s PCP if their child’s test is negative and they have follow-up questions.  We are letting families know we will have their results within 48-72 hours of testing.

Q: Does Seattle Children’s offer drive-through testing for staff with symptoms of COVID-19?

A: On March 13, Seattle Children’s began offering testing for workforce members who have symptoms of COVID-19 (fever, cough, difficulty breathing). At this time testing is available to Seattle Children’s workforce who have a badge. This includes active community medical staff members with a Seattle Children’s badge.

Q: Will Seattle Children’s offer drive-through testing for patients with symptoms of COVID-19?

A: Seattle Children’s is exploring drive-through testing for patients that meet criteria. Testing will be ordered by providers and will align with current recommendations to ensure we can maintain adequate testing supplies.

 

Changes to Scheduling

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, including EKG and EEG appointments. 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

Q: Are you offering provider ambulatory telemedicine and telephone visits?

A: Seattle Children’s is swiftly changing our care model to meet the clinical needs of patients during the COVID-19 outbreak by expanding our telehealth platform and offering telephone visits instead of in-person appointments when medically possible. We are working to shift in-person clinic visits to telemedicine and telephone visits when possible.

The Office of Civil Rights (OCR) issued a statement that allows enforcement discretion of normal HIPAA rules.

OCR will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency. This means that non-public-facing applications are approved during this period of time. However, if these applications are linked to your personal device, patients will see your personal information (e.g., cell phone number).

Q: Any other changes in scheduling?

A: Seattle Children’s Contact Center is temporarily shortening its hours to close to inbound calls at 5 p.m. rather than 6 p.m.  New inbound calling hours will be 7 a.m. to 5 p.m. Outbound calls will still occur until 6 p.m.

Q: Are surgeries continuing?

A: Based on CDC recommendations for Seattle-King, Pierce and Snohomish County, Seattle Children’s will cancel all elective surgeries and procedures until further notice. The temporary cancellation of elective surgeries has gone into effect and we have been calling patient families to notify them. PCPs will be notified through our standard channels. We will continue to perform urgent surgeries and procedures during this time. We understand canceling surgeries will have a major impact on the lives of patients and families and appreciate your support while our community is going through this public health emergency.

 

Changes at our Hospital Campus

Q: Are you accepting older patients?

A: With other hospitals in the area already seeing patient surges that are straining their resources, Seattle Children’s has agreed to begin accepting inpatients up to and including age 21. Doing so will help provide additional space at other hospitals to serve the adult population.

Q: If one of my patients is an inpatient at Seattle Children’s, what can they expect?

A: The clinical staff and providers at Seattle Children’s are trained on the identification, isolation and treatment of COVID-19 and other infectious diseases. At this point in time:

  • If an inpatient does not have cold or flu-like symptoms, they will continue to receive care without change.
  • If the primary caregiver has symptoms of fever or cough, they should not visit.
  • To protect our patients, families and staff from a possible exposure to COVID-19, we currently allow only one primary caregiver to visit a patient.

The situation with COVID-19 is evolving rapidly and procedures for patient care will necessarily change to best protect patients, their families and staff.

Q: Has your visitor policy changed?

A: To align with the practices of many of our partners in the Children’s Hospital Association, Seattle Children’s is now allowing only one visitor at a time per patient. This applies to both inpatients and clinic patients including those visiting the ED and urgent care. This step will be challenging for our patients and families, but it is essential to limiting potential exposure to the virus that causes COVID-19. For inpatients, up to four parents or caregivers can be designated, but only one can visit at a time.

Q: Are you screening visitors?

A: All patients and visitors are being screened for COVID-19 at our facility entrances. As we learn more about the coronavirus and the symptoms it can cause, we’ll continue to assess our entrance screening process and make adjustments as necessary to help keep our workforce members and patients safe. Based on recent findings about the virus, we have added additional symptoms to our entrance screening process.

View our screening algorithms for:

Visitors to the Lab who screen positive will be escorted to a negative pressure room and have their labs drawn in the negative pressure room, rather than diverted to the ED.

 

Changes to our Ambulatory Services

Q: Are there any changes to Seattle Children’s outpatient radiology services?

A: We are continuing to offer a full range of imaging services including diagnostic outpatient x-ray in Bellevue, Federal Way, Everett, and Seattle – but we ask that you please help us promote social distancing and preserve supplies and equipment by delaying all non-emergent imaging studies. 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.

X-rays now require an appointment: Families who need diagnostic x-rays at Seattle Children’s are now required to schedule an appointment.  We are no longer accepting walk-in patients. Families should call 206-987-2089 to schedule an appointment. Schedulers are available to schedule these studies from 7 a.m. to 6 p.m., Monday to Friday. We will evaluate urgency and consider less investigative studies when appropriate.

X-rays can still be done as part of an urgent care visit.

Q: are there any changes to Seattle Children’s laboratory services?

A: Laboratory hours at our South Clinic in Federal Way and North Clinic in Everett have been slightly reduced to 7:45 a.m. to 4 p.m. on Saturdays (closed for lunch from 11 to 11:30 a.m.). Monday through Friday hours at these two clinics remain 7:30 a.m. to 6 p.m., closed Sunday. View our Laboratory Medicine and Pathology website for a full listing of all our lab locations and hours. Labs continue to be open to walk-in visits, with COVID-19 screening in place at entrances.

Q: Will there be changes to Seattle Children’s Ambulatory Clinics? 

A: As part of our response to COVID-19, we have closed the following clinics to in-person visits: Olympia Clinic, Seattle Children’s Sleep and Psychiatry and Behavioral Medicine at Overlake, and South Sound Cardiology Clinics in Centralia, Federal Way, and Silverdale. We are contacting patients who have appointments to reschedule them or change to telephone visits. Seattle Children’s is assessing the operating hours of other clinics and may close or reduce hours in some locations. Patients with appointments that must occur in person may be asked to travel to another location. At this time, we plan to keep all Urgent Care locations open. We may modify Urgent Care hours or staffing due to low volumes.

 

Changes to ED or Urgent Care

Q: When should PCPs send patients to Seattle Children’s Emergency Department (or not)?

A: 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.

Q: Are there any changes to Seattle Children’s Urgent Care?

A: Our Urgent Cares continue to have capacity. Only one caregiver is allowed to accompany a patient to their appointment. 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.

 

Changes to Classes and Courses

Q: Are classes and courses continuing at Seattle Children’s?

A: Our PALS, PEARS, NRP, ACLS, CPR and BLS classes are canceled.

The American Heart Association has issued a global 60-day grace period for all life support certifications. Based on this and new guidance from the Centers for Disease Control and Prevention (CDC), Seattle Children’s is canceling our Basic Life Support (BLS), Neonatal Resuscitation Program (NRP), Pediatric Emergency Assessment, Recognition and Stabilization (PEARS), Cardiopulmonary Resuscitation (CPR), Advanced Cardiovascular Life Support (ACLS), and Pediatric Advanced Life Support (PALS) courses until further notice. Healthcare workers can continue working up to 60 days beyond expiration of their certification.

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 the most up-to-date information about COVID-19, please visit:

For additional information to support families, see:

Seattle Children’s Panel Discussions on COVID-19

  • COVID-19: The Seattle Children’s Experience: Seattle Children’s infectious disease and emergency medicine experts shared their experiences from the front lines at the epicenter of the COVID-19 outbreak in the United States. This event includes a Q&A on how to prepare. Watch the video.
  • Confronting Tragic Choices in the Midst of a Pandemic: Our regional disaster healthcare network is one of the few in the country that has been focused on planning around a severe pandemic. Watch our panel discussion on how decisions are made when resources are scarce.

New Information Line for Families

Current patients of Seattle Children’s, their family member or a parent of a child under the age of 19 in our community can now call us toll free at 1-833-987-2100 to learn how Seattle Children’s is responding to this pandemic. Families can also fill out our contact form with their questions and member of our staff will call you to answer your questions. The line is open 8 a.m. to 5 p.m., 7 days a week.

This information line does not provide:

  • Medical advice or symptom triage related to COVID-19 or other medical conditions. Families should talk with their primary care provider about care recommendations.
  • Test results or other information about COVID-19 testing. Families who were tested at a Seattle Children’s location should wait to be called with results.
  • Scheduling or cancelling appointments. Over the coming days and weeks, our clinics will call families to either reschedule or convert appointments to telemedicine or telephone visits when possible. Families should call their clinic directly for questions about upcoming appointments.