EMHS Post COVID-19 Clinic

East Metropolitan Health Service (EMHS) has commenced a Post Covid-19 Clinic, based at Bentley Health Service and led by a Senior Physiotherapist, to see patients aged over 16 years living in the EMHS catchment who are still experiencing non-urgent significant symptoms at least twelve weeks from the date of positive SARS-CoV-2 diagnosis (confirmed by positive RAT or PCR) and where other causes have been excluded where appropriate.

How to refer

GPs can refer for patients meeting the referral criteria below to the EMHS Post-COVID Clinic via the Central Referral Service (CRS).

Suitable patients referred to subspeciality clinics following earlier advice are being diverted to the Post-COVID Clinic, so these do not need to be re-referred.

Referral Criteria

To be eligible for review by the RPBG Post COVID-19 Clinic, patients referred will need to be:

  • aged over 16 years
  • residing within the EMHS metropolitan catchment, or Kimberley, Pilbara and Wheatbelt patients unable to be managed locally (according to current WACHS Link pathways),
  • be at least twelve weeks from the date of SARS-CoV-2 diagnosis (confirmed by positive RAT or PCR),
  • be experiencing ongoing non-urgent significant symptoms and objective physical findings without other obvious cause on the GP screen below, or cognitive/psychological concerns that are failing to resolve with primary care and that the GP feels warrant further review, and,
  • where the GP screen does not detect conditions more suitable for direct referral for sub-specialty medical review or Community Rehabilitation.

Patients presenting to their GP with post-COVID-19 concerns should be screened, as appropriate according to their presenting syndrome (condition), with:

  • routine clinical assessment that considers physical, psychological and social domains
  • blood tests (FBP, CRP, ferritin, D-dimer)
  • if significant shortness of breath and/or decreased exercise tolerance without other known cause, the referral should include the results of:
    • ooximetry (if possible, at rest and on exertion)
    • spirometry,
    • a chest x-ray (PA and lateral); and
    • recent clinically appropriate investigations (echo and CT thorax) to rule out cardiac failure or pulmonary disease
  • if significant cognitive symptoms including “brain fog” without other known cause, the referral should include the results of
    • cognitive screen (MMSE or AMTS) if presenting with confusion or cognitive concerns
    • recent clinically appropriate investigations (e.g., CT Brain)

If these tests are indicated, but not able to be completed (e.g., rural/regional patients) the reasons should be specified in the referral.

During the trial period of this clinic, specific referral access criteria may be developed further depending on volume and need.

The Post COVID-19 Clinic offers further assessment, triage and management/advice for patients with ongoing COVID-19 symptoms beyond 12 weeks who GPs assess as unlikely to require sub-specialty medical review. Where the patient’s symptoms are likely to be due to the development or exacerbation of a condition(s) for which referral for sub-specialty medical review, or to Community Rehabilitation, is clinically appropriate, GPs can refer to those as usual.

Exclusion Criteria

  1. All patients with ‘red flag’ symptoms:
    • severe, new onset, or worsening breathlessness or hypoxia
    • syncope
    • unexplained chest pain, palpitations or arrhythmias
    • new delirium, or focal neurological signs or symptoms

      These patients will require urgent assessment to exclude a serious complication of COVID-19, or an alternative diagnosis.

      These patients should self-refer to ED, or GP refers for urgent assessment, usually via the Emergency Department, or a site based urgent access pathway, to exclude a serious complication of COVID-19, or alternative diagnosis.

  2. Patients whose symptoms are found or suspected on history, examination and/or investigation to have another cause requiring sub-specialty medical review.
  3. Patients residing outside of EMHS metropolitan or rural catchment.
  4. Rural patients who are able to be managed locally, (according to current WACHS Link pathways).
  5. Patients aged 16 years or younger.

The EMHS Post-COVID-19 Clinic is trialling a Senior Physiotherapist led model of care for initial assessment and triage of patients referred to the Post COVID-19 Clinic, using virtual assessment and follow-up where possible.

Assessment outcomes and management plans will be communicated to the patient’s GP and where indicated, patients will be on-referred to community or other EMHS services.

Telephone support for GP queries will also be available.

GPs wishing to discuss Post COVID referrals, investigations or management can contact the clinic’s Senior Physiotherapist by telephone on 0481483611.

As this clinic operates part-time, voicemail can be left on the clinic telephone number. The Physiotherapist will endeavour to return GP calls as soon as possible.

Long COVID and Post-COVID Syndrome Resources

Useful resources for GPs include:

 

 

Last Updated: 28/10/2022