The aim of this game is to keep services running for patients at as full a scope of practice as is possible – routine care, immunisations, cervical screening, as well as routine appointments and managing acute care.
For a team of 12 you will need...
One bag containing:
A second bag containing:
Coloured cards with associated scenarios – find these below, copy the text and print onto cards.
The setting is the real life one of the practice team – their clinic, their community, their town.
Each person assumes their own role in the practice – admin, nurse, GP, manager etc.
The team allocates one person to observe and make notes – this person does not participate, their role is to keep time, observe the team and make notes about what is learned, to identify where there are gaps and to feedback to the team at the end of the scenario.
This game is described for a team of 12 participants (plus one observer), but for smaller or larger teams, simply add more counters to the bags – your choice of colours will make it easier or harder for the team to keep delivering services.
For each team member a token or counter of various colours are put into the first bag. This bag is used to identify the index case, and the close contacts of that case.
Into this bag place one red counter which represents the COVID-19 case, a number of orange counters (9) that represent close contacts and (2) green counters.
To assign your index case all team members randomly select a counter from the first bag – until the red counter is chosen, all counters except the red one are then replaced in the bag.
The person who picks the red counter is given the red scenario card and round one can begin.
Red card scenario
It is Thursday night at 18.30 after a very hectic day at work, which has come on top of a very hectic week.
You have had a bit of a runny nose for the past three days and decided yesterday to have a COVID-19 swab although you really didn’t feel you have been at risk. Unfortunately, your result has come back positive and the public health unit (PHU) has contacted you this evening.
They have told you to self-isolate at home, your immediate family members are also to self-isolate and get tests done as soon as they can. They will contact you tomorrow to do more detailed contact tracing. They ask you where you work and ask you to tell your colleagues what has happened as soon as you can.
You are to tell your colleagues the PHU will be in-touch with all your close contacts once they have completed the contact tracing over the next 24 hours.
The team have 10 minutes to respond – what would you do next?
The remaining team members then select the remaining counters from the first bag.
The team members (9 in our example) who select the orange counters are given a orange scenario card, those who pick a green (2 in our example) counter are given a green scenario card.
This time the team has 10 minutes to respond to the orange and green scenarios – what would they do next?
Orange card scenario
It is 2pm on Friday afternoon. Contact tracing has identified you as a close contact of COVID-19, you are asymptomatic. The public health team have advised you to self-isolate at home, your family members should get a swab and self-isolate if they have symptoms. You will have a COVID-19 swab in three days, and again in 12 days. If both of these tests are negative you will be allowed out of self-isolation but if you develop symptoms at any time you have been asked to let them know.
Green card scenario
You are told you are not a close contact. You do not need to self-isolate and can continue life as normal.
The “day three tests” are back. It is time to open the second bag and learn about the results.
Read the scenarios and the team has five minutes to respond – what would they do next?
Yellow card scenario
Your test result on day three is positive. This means you need to continue self-isolation at home for another 14 days whatever your day 12 test results say. All you family members will also need to self-isolate and have a test. The PHU will undertake close contact tracing with you over the next 24 hours.
Blue card scenario
Your test result on day three is negative. You need to continue to self-isolate until after your day 12 result is known. Your family members do not need to self-isolate but should get a test if they become symptomatic.
All the day 12 results are negative. Hurrah! The blue team members are allowed back to work. The infected red and yellow counter holders all remain well but have to remain off work for 14 days after they were diagnosed. This all works out well and after a total of 18 days the whole team is back to work.
The observer should now feed back on what they observed.
As a team discuss what was learned and what the team need to set up in order to be able to manage in the event of an outbreak involving one of the team.
Finally, give the team the “in an ideal world” card to consider and discuss.
In an ideal world card
The practice has an effective phone-tree that allows them to contact all staff members quickly, they call a meeting for everyone to hear what everyone knows at the same time, and arrange regular team meetings throughout the event to keep everyone in touch.
The practice can demonstrate to the PHU that they have applied “green” “amber” “red” streaming of patients with appropriate PPE and cleaning of their clinical areas that has minimised risk to patients will keep the building open.
Early in their response they have decided who is the team leader, who is the clinical advisor, who is in charge of communications, and who is in charge of any logistics and orders. They have agreed rules around confidentiality and ensured that no-one is going to be talking to the press or sharing news on Facebook unless it is through official channels.
The practice has an active telemedicine service in place which allows their clinicians to work from home and provide signatureless e-prescriptions, e-referrals, and a mixture of phone and video consultations.
The practice has a pre-agreed relationship with a friendly clinic who can pick up the “in-person” consultations that they cannot provide.
The practice is well supported and connected with their PHO team.
The team leader reads out the cards, keeps time, and a record of what is learned – they are an observer and do not contribute to the discussion.
Your mission, if you choose to accept it, is to ensure your patients have access to the full scope of general practice services throughout whatever comes next…
A clinician in the practice became symptomatic and was diagnosed with COVID-19 last night. Public health have been in touch and asked you to undertake a “deep clean.” They have told you to look on the Ministry of Health website for what this means. They are interviewing the patient for contact tracing, but until this is done they are asking everyone who worked with the clinician over the past two days to go home and self-isolate.
Discuss for 15 minutes – what do you do next?
Discussion prompts for the team leader
It’s the next day and public health have organised testing for all close contacts of the case, which is determined to be all staff members in the clinic. This is to happen on day three and day 12 after the diagnosis was made. They have asked everyone to self-isolate until the results are known. For your team this means no-one is available to physically go back into the practice.
Discuss for 10 minutes – how are you going to maintain services to your patients?
Discussion prompts for the team leader
It is day 14 – Everyone is clear. Great news. We can all return to work.
Discuss for 10 minutes - what have you learnt as a team?
The team leader summarises what they observed, and what gaps they have identified that need to be filled. The team allocates who will do what by when.
Finally, give the team the “in an ideal world” card (as above) to consider and discuss.