Table 3.

Changes to service provision

Service schedule 1. Reschedule non-essential or non-urgent face-to-face appointments and OPDs where appropriate and acceptable to the patient to help minimise risk and help maintain social distancing 2. Immediately suspend all group therapies in keeping with social distancing requirements. Care coordinators or group therapists to make contact with clients by phone to provide support while tele-health options (group or individual) are arranged where possible 3. Move day community psychosocial programmes (Club 84 and the Gully) to videoconference platform to support ongoing social engagement Tele-health 1. Conduct service-level evaluation of tele-health options for assessment, service delivery and support (e.g. HealthDirect or another agreed and secure platform) 2. Where possible and appropriate, use tele-health and phone contacts 2.1 Do case-by-case review of appropriateness and usefulness of the tele-health platform for individual patients, as this requires the patient to have a reliable phone or computer; judgement of affect and rapport may be limited and distress may be more difficult to manage remotely 2.2 If patient has no access to telephone or internet connection and tele-health is considered appropriate, explore access options via next of kin or family: investigate if patient can be supported to access to technology via support funding and non-government organisations 2.3 If patient has no access to telephone or internet connection, use face-to-face assessment. Alternatively, to maintain social distancing by minimising number of people in a room, consider combined face-to-face and videoconference consult, with one or more staff visiting face-to-face and another attending via videoconference on staff member’s phone 2.4 Adhere to Did Not Attend (DNA) protocol if patient does not answer scheduled consult or cannot be reached: attempt contact twice, contact next of kin, perform risk assessment, document and discuss with line manager and care coordinator to arrange follow-up call, face-to-face visit and/or liaison with other members of care team such as GP Clozapine clinics 1. Rationalise reviews considering the level of medical comorbidity and risks of accessing clinic in line with current Office of the Chief Psychiatrist (OCP) and Clozaril Patient Monitoring System (CPMS) guidelines (currently recommended: face-to-face contact with clinical staff reduced from monthly to two-monthly). Continue usual investigations as per protocol and re-evaluate as new guidelines emerge. If the patient has been on clozapine long term (greater than 1 year) continuously, with nil history of neutropaenia there may be a rationale for the frequency of blood tests to be reduced further during the pandemic as peak incidence of neutropaenia is within the first few months of starting therapy and is negligible after 1 year, but this is undergoing further evaluation and has not yet been formally incorporated into practice guidelines.12 Depot clinics 1. Review alternative service delivery (such as home visiting) with risk assessment to determine appropriateness on a case-by-case basis Changes to process for home visiting 1. Make phone calls prior to visits to ascertain presence of illness at the home via Community Based Information System (CBIS) Screening questions 2. Use the CBIS Novel Respiratory Pathogen Screening Tool checklist during phone and remote contacts and prior to face-to-face contacts to screen for symptoms of COVID-19 (with mandatory questions of: cough, sore throat, headache, fever or history of fever, shortness of breath, diarrhoea), medical comorbidities (diabetes, cardiovascular disease, respiratory disease, obesity, renal disease), travel history (within last 14 days, domestic or international to a region with sustained human-to-human transmission or outbreak), exposure (contact with confirmed case) and any COVID-19 testing results 3. If patients develop symptoms suggestive of COVID-19 (self-reported, detected on clinical encounter on history or on screening), facilitate testing and appropriate care Use of personal protective equipment (PPE) 1. Use personal protective equipment (PPE) during face-to-face contacts in accordance with SA Health Policy23 2. When seeing a patient not suspected of having COVID-19, observe social distancing (1.5 m) unless unavoidable (e.g. physical examination), practice hand hygiene, with no requirement for PPE 3. Attention to travel alerts: if a patient has epidemiological risk factors such as travelled overseas in the last 14 days, interstate in the last 7 days or other relevant known risks at time of review, delay team assessment if appointment until after the 14-day quarantine period. If unable to reschedule appointment, clinical staff to wear PPE (surgical mask, protective eyewear, long sleeve gown and gloves) when assessing the patient 4. When seeing a symptomatic patient with confirmed or unconfirmed COVID-19, undertake contact and droplet precautions (gown, gloves and eye protection for the clinician and mask for both staff and the patient)