28 Feb 2020 | | Testing was expanded to include Iran, Italy, Japan and South Korea, whereas previously testing was only available to those who visited China Stanford aligned with CDC guidance
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2 Mar 2020 | | Within Stanford protocol, security staff replaced by nurses to screen patients for country of travel Complex screening protocol necessitated change to a staff member with clinical background
| | Create Urgency (stage 1) Form a powerful coalition (stage 2) Create a vision for change (stage 3) Communicate the vision (stage 4) Remove obstacles (stage 5)
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4 Mar 2020 | | Testing was expanded to any symptomatic patient with symptoms of severe lower respiratory illness requiring hospitalisation Testing able to be done in-house, and no longer requiring county health department approval for testing and processing.
| | Create a vision for change (stage 3) Communicate the vision (stage 4) Remove obstacles (stage 5) Build on the Change (stage 7)
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7 Mar 2020 | | | | |
9 Mar 2020 | | Standardised discharge instructions were made available for patients being discharged with results pending. COVID-19 results pending admission pathway was added with cohorting of patients awaiting results in the hospital. Any patient being admitted with influenza like illness was tested for COVID-19
| Weekly departmental newsletter Leadership rounding consisting of Chair and Medical Director to observe effectiveness of changes and boost morale Interdepartmental meetings among clinical leaders
| Form a powerful coalition (stage 2) Create a vision for change (stage 3) Communicate the vision (stage 4) Remove obstacles (stage 5) Create short-term wins (stage 6) Build on the change (stage 7)
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11 Mar 2020 | | | Updated posted flowchart Leadership rounds with nurse quality manager, medical director, nurse manager Weekly residency conference updates by chair
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13 Mar 2020 (I) | | | | Create urgency (stage 1) Communicate the vision (stage 4) Remove obstacles (stage 5) Build on the change (stage 7)
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13 Mar 2020 (II) | | | | Form a powerful coalition (stage 2) Create a vision for change (stage 3) Communicate the vision (stage 4) Remove obstacles (stage 5) Build on the change (stage 7) Anchor the change (stage 8)
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5 Apr 2020 | | Broadened testing criteria for asymptomatic and unable to screen patients (eg, dementia, stroke patients) Rapid result COVID-19 testing offered for specific patient presentations
| | Create a vision for change (stage 3) Communicate the vision (stage 4) Remove obstacles (stage 5) Create short-term wins (stage 6) Build on the change (stage 7) Anchor the change (stage 8)
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