The COVID-Prepped Medical Practice

As Delaware has begun easing restrictions on businesses, doctors are carefully moving toward re-opening medical practices. Doing so presents a unique set of challenges – from seeing patients who may have COVID-19 to putting new safety and administrative measures in place. In this article, some of the industry’s leading experts share best practices for mitigating risks and resuming in-person medical care.

Consideration #1: Staff – Who will come back and when?

Whether a primary care, specialty care, or surgical practice, determining how quickly the office will reopen and who will be involved is one of the first steps. The American Medical Association (AMA) suggests taking an incremental approach that limits the number of staff and patients in the office each day. This can be accomplished by alternating work schedules, utilizing remote workers, and bringing employees back in stages.

One of the easiest ways to narrow down who will staff the practice in person is to ask who is willing. It’s important to be mindful that staff may still have fears surrounding exposure to COVID-19, especially in a medical setting. Debbie Kane Hill, a registered nurse at The Doctors Company recommends, “Acknowledge the need to provide emotional support to staff who may be dealing with fear or other stressors.” She suggests connecting them with an employee assistance program or other support resources.

Consideration #2: Office – How will risk of infection be minimized?

To help prevent transmission of COVID-19, the AMA recommends ordering PPE and other supplies in advance of reopening. The CDC has published a comprehensive list of infection control measures. While this complete list can be found on the CDC website, a brief overview is provided here.

Health Care Staff Precautions:

• Assign a staff member to perform daily screenings of all staff working on-site. Sick employees should stay home and follow CDC return-to-work guidelines.
• Whenever possible, health care staff should wear face masks rather than cloth face coverings for the duration of their shifts. Cloth face coverings are not PPE and do not offer adequate protection against splashes and sprays of infectious material.
• Designate areas for health care staff to unmask for breaks while remaining at least 6 feet from others.
• Emphasize the need to perform proper hand hygiene; follow the CDC hand washing protocol for health care providers.

Patient Precautions:

• Utilize CDC guidelines to screen patients for respiratory symptoms when scheduling appointments.
• Screen again during the appointment reminder and again upon arrival for the appointment.
• Obtain needed documents and consents electronically when possible before the visit to minimize the exchange of paperwork and touched surfaces (e.g. clipboards, pens).
• Develop and communicate pre-visit instructions for patients, such as having the patient call from the car when arriving for their appointment.
• Stagger appointments to limit the number of people in the waiting room, exam rooms and triage areas.
• Instruct patients and visitors to wear their own cloth face covering throughout their appointment. If they do not have one, they should be offered a disposable face mask*.
• Restrict visitors from accompanying patients unless the visitor is needed to support a patient’s physical or emotional well-being.

Office-based Precautions:

• Create and follow a cleaning checklist and schedule for disinfecting hard surfaces and anything handed to a patient (e.g. a clipboard).
• Limit and monitor office entrances.
• Create COVID and non-COVID care areas when possible to minimize infection transmission.
• Set chairs in waiting areas at least 6 feet apart. Remove magazines, brochures, toys, etc. to limit surfaces where viruses can live.
• Install protective barriers between staff and patients in registration & check-out areas.
• Post visible signage instructing patients to wear a face covering while in the office, maintain a 6-foot distance from others, and perform hand hygiene.
• Provide alcohol-based hand sanitizer, tissues, and no-touch trash receptacles in the waiting room and at patient registration/check-out.

Consideration #3: Patients – Who should be seen in-person and when?

Deciding how to assess and prioritize which patients need to be seen in person can be a challenge. The CDC recommends that medical practices “prioritize services that, if deferred, are most likely to result in patient harm.” The Centers for Medicare & Medicaid Services (CMS), more specifically, recommends prioritizing “surgical/procedural care and high-complexity chronic disease management.”

In general, medical practices will want to triage patients according to presenting symptoms and severity. Staff should additionally contact high-risk patients to ensure they are sheltering in-place, adhering to their care plan, have needed medications, and know to call if they experience respiratory symptoms. Patients who can continue telehealth should be scheduled to do so.

Staying Adaptable

Assuring the safety of your staff, patients, and practice in the wake of COVID requires thoughtful and careful planning. While Delaware has flattened the curve, spikes are beginning to reoccur. Health care practices must be prepared to adjust and adapt as COVID-19 continues to change the medical landscape.

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* Face masks and cloth face coverings should not be placed on young children under age two (2), anyone who has trouble breathing, or anyone who is unconscious, incapacitated or otherwise unable to remove the mask without assistance.

Note: This article represents a compilation of information published by others and does not constitute medical, legal, financial, or consulting advice. All information is believed to be current and accurate at the time of posting. References and links to third parties do not constitute an endorsement, sponsorship, or warranty, expressed or implied.

RESOURCES:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/hand-hygiene.html

https://www.thedoctors.com/articles/guide-to-reopening-your-medical-office-during-covid-19/

https://www.ama-assn.org/delivering-care/public-health/covid-19-physician-practice-guide-reopening

https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf