Vulnerable Populations

Discharge and management information for vulnerable populations.

Please recommend the following:

  • Practice respiratory hygiene, including during feeding (i.e. use medical mask when near a child if the mother has respiratory symptoms)
  • Perform hand hygiene before and after contact with the child (washing her hands with soap and water for at least 20 seconds before touching the infant or any pump or bottle parts during the process of feeding)
  • Routinely clean and disinfect surfaces with which the symptomatic mother has been in contact
  • Offer resources for breastfeeding counseling, basic psycho-social support, and practical feeding support

Source: WHO, ACOG, and CDC

Last Updated 5 months ago
  • Please contact local health department or government authorities about temporary isolation units that can house these populations for quarantine/isolation
  • Further organization of transport of patients to isolation sites should be coordinated with local shelters and outreach teams

Source: CDC and CDC Handout

Last Updated 5 months ago

Under the Americans with Disabilities Act and Rehabilitation Act, hospitals and other medical facilities are required to provide appropriate in-person and/or remote sign language interpretation services as well as textual English communications to patients and/or companions who are deaf, hard of hearing, or deaf-blind.

  • Recommend that if possible, Hospitals and medical facilities should place deaf, hard of hearing and deaf-blind patients in a unit with accessible WiFi as communication devices depend on internet connectivity
  • Some deaf, hard of hearing and deaf-blind patients may not have smartphones; hospitals should at a minimum have whiteboards or yellow pads and markers on hand to facilitate basic communication
  • If you have a patient who is deaf-blind, please consult the guidelines from the DeafBlind Interpreting National Training & Resource Center

Source: Nebraska Medicine

Last Updated 5 months ago

American Society of Nephrology Joint Statement with the American College of Emergency Physicians

  • Dialysis facilities should implement measures to identify patients with signs and symptoms of respiratory infection (such as fever and cough) at or prior to arrival at a dialysis facility (before patients enter the treatment area).
  • When COVID-19 is suspected or confirmed in a hemodialysis patient, dialysis staff should follow the CDC’s “Interim Infection Prevention and Control Recommendations.”
  • Unless a patient is too sick, dialysis is most appropriately provided at an outpatient dialysis center. 
  • In the context of COVID-19, mild symptoms that do not require hospitalization should not be referred to the emergency department.
  • If a patient is being referred to the emergency department for a complaint that is not a time-dependent emergency, the dialysis center should discuss the case with their medical director and with the emergency department before sending the patient.

Source: ACEP

Last Updated 5 months ago

Patients with Substance Use Disorder:

For patients discharged from ED or floor who were COVID-19 Positive: 

  • Consider writing longer prescriptions, including up to 30 days if you are comfortable doing so.
  • For assistance with prescribing buprenorphine, use ACEP’s BUPE tool
  • Consider distributing naloxone from ED or assisting patients in finding resources for free naloxone.
  • To help with therapy, can also refer patients to online group therapy and other apps.

Additional Resources:

Discharge Instruction Template from Harm Reduction Coalition, full printable PDF found here

 

Source: ACEP  and American Society of Addiction Medicine

Last Updated 5 months ago

During discharge, patients may or may not share if they are at risk for domestic abuse. If suspected, please refer to the following resources: 

  • National Domestic Violence Hotline: It is 24/7, confidential and free: 1-800-799-7233 and through chat. By texting LOVEIS to 22522, Crisis Text Line, which addresses a range of issues, can be reached by texting HOME to 741741 and via Facebook Messenger from the organization's website
  • The National Sexual Assault Hotline: It is 24/7, confidential and free: 800-656-HOPE (4673) and through chat.
  • The Network: The Network/La Red’s 24-hour hotline provides confidential emotional support, information, referrals, safety planning, and crisis intervention for lesbian, gay, bisexual, queer and/or transgender (LGBQ/T) folks who are being abused or have been abused by a partner. Call 617-742-4911 (voice) or 800-832-1901 (Toll-Free).

Source: Coronavirus Tech Handbook

Last Updated 5 months ago

Most severely ill people with psychiatric illnesses have high rates of baseline medical comorbidity, have reduced access to primary care medical resources, and may lack resources to participate in telehealth services. As a result, this group may be more vulnerable to COVID-19 and have limitations in accessing services other than in emergency and crisis settings.

Source: Joint Statement by the American Association for Emergency Psychiatry, American College of Emergency Physicians, American Psychiatric Association, Coalition on Psychiatric Emergencies, Crisis Residential Association, and Emergency Nurses Association

Last Updated 5 months ago
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