3. Ascertain Whether Your Patients Are Ill
One day prior to a patient’s appointment, Dr Stewart’s staff call the patient to make sure they are not sick with fever or cough or other symptoms that might suggest COVID-19. “That way they won’t make an extra visit to our office if they are sick with symptoms consistent with COVID-19, because we are asking patients with suspected COVID-19 to do a televisit or phone visit rather than come to the office in person,” she said.
Patients who come in person have their temperature checked as soon as they enter the office and also fill out a questionnaire asking about cough, fever, chills, and shortness of breath. If they are having these symptoms, they are asked to return home and have their appointment by phone if possible.
However, some of these patients may need to be tested for COVID-19. Dr Stewart’s practice does not have the capacity to do COVID-19 testing, but she refers patients to other local facilities that do testing. The AAFP has issued guidance for physicians regarding who should be tested and what types of tests are available. The office of the US Department of Health and Human Services offers a guide to locating local community-based testing sites. Additional information can be obtained from state and local health departments.
If you do see a patient who has symptoms suggestive of COVID-19, try to restrict them to a special time so that they don’t intersect with patients who are having well visits, sanitize and disinfect areas where they have been and consider having a separate dedicated entrance for them if possible. In general, it is advisable to stagger patient appointments and to see patients who are ill at a different time than those who are well or to offer telehealth visits.
4. Make Personal Protective Equipment (PPE) Available for Everyone
All patients should wear masks, Dr Stewart stated. The Centers for Disease Control and Prevention (CDC) provides instructions how to make a cloth face covering or mask from household items.
“Our practice is a federally qualified health center where we have many uninsured people, some of whom are homeless and unable to make their own masks or obtain masks, so we give masks out to anyone coming into our office who might need them,” Dr Stewart recounted.
For staff, masks and gloves are essential, and—depending on the nature of the practice and specialty—clinicians and others interacting with patients might need full-face coverings or other protective clothing.
Prior to reopening, it is important to assess what PPE supplies you have available and, if possible, have them delivered in advance so that they are on hand as needed. Also, know what your mechanism will be for reordering when they start to run low.
5. Reopen in Stages
Do not throw your doors open and return to “business as usual,” Dr Stewart advised. Instead implement a step-by-step process, beginning with opening part-time, slowly starting to conduct in-person visits.
“Some recommendations suggest having one-third of the practice open for in-person visits and conducting the remaining appointments remotely via telehealth, and then gradually and incrementally increasing the in-person visits,” Dr Stewart said.
The AAFP recommends evaluating the necessity of in-person care “based on clinical needs and individualized care for each patient” and suggests “prioritizing high-complexity chronic condition management and patients with illness” and determining the necessity of preventive services on each individual patient’s needs.