6. Consider Shifts for Office Staff

“Some of my colleagues divided their office team into shifts, with one group of staff working in the morning and the other in the afternoon, and possibly a third group working in the evening,” Dr Stewart said. This minimizes the number of hours that a given staff member is exposed to patients, so if a patient who enters the office turns out to test positive for the virus, the entire staff has not been exposed. 

“Unfortunately, we had that problem at the beginning of the COVID-19 pandemic in our office,” Dr Stewart reported. “We had 3 positive patients and had to close down our entire office and be quarantined for 14 days, followed by a thorough cleaning following OSHA guidelines. So making sure that fewer staff members are in the office at a given time reduces that risk.”

If a staff member has to be quarantined, the practice tries to assign as many televisits as possible to him or her so that they are still considered to be working, even while not in the office, Dr Stewart added. 


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The issue regarding paid sick leave for employees who may have been furloughed is complex and it is important for practices to consider the implications of quarantining staff. Further information is available here

7. Limit Non-Patient Visitors

The American Medical Association (AMA) recommends limiting individuals who are not patients from visiting the office (eg, vendors, educators, service providers) and instead utilizing virtual methods to communicate with them. If a non-patient (such as a repair-person) must enter the office, a window of time outside of normal patient hours should be designated. 

8. Notify Patients, Staff and Other Relevant Individuals About Your Policies 

Make sure that all of your practice policies are posted and known to both patients and staff through signage and through digital methods (eg, on your website and/or through a newsletter).

Notifying patients of your policies will also allay their fears about in-person appointments, Dr Stewart noted. 

“We have seen many reports4,5,6 of people who have had strokes or heart attacks or increased symptoms of chronic illnesses but have been reluctant to get medical care because they are afraid of contracting COVID-19,” Dr Stewart said. “We are trying to encourage them and reassure them regarding measures we are taking to ensure their safety and explaining how their visit will be different from what it was prior to the pandemic.” 

9. Remain Cognizant of Confidentiality and Privacy Regulations

Many of the usual HIPAA requirements related to telemedicine have been relaxed during the pandemic because it is a public health emergency. 

However, this does not mean that all privacy regulations have been suspended. General HIPAA regulations, security, and breach notifications and precautions remain in effect. 

10. Remain Updated About New Developments and Updated Guidance Regarding COVID-19

Physicians should remain cognizant that this is a rapidly and continually evolving situation and that, although some regulations are being relaxed as the country reopens, there might be an increase in cases. Patients should be reminded that social distancing, hand sanitizing, and face covering are still important and that they must continue to take adequate precautions during this uncertain time. 

Resources for physicians to consult include:

American Medical Association

American Academy of Family Physicians

Association of State and Territorial Health Officials

Centers for Disease Control and Prevention

References

1.    Centers for Disease Control and Prevention (CDC). CDC Releases Framework for Health Care Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic. May 12, 2020. Available at: https://www.cdc.gov/oralhealth/infectioncontrol/statement-COVID.html. Accessed: May 16, 2020.

2.    American Medical Association (AMA). COVID-19: A Physician Practice Guide to Reopening. May 1, 2020. Available at: https://www.ama-assn.org/delivering-care/public-health/covid-19-physician-practice-guide-reopening. Accessed: May 14, 2020.

3.    American Academy of Family Practice (AAFP). Considerations for Re-opening Your Practice. Available at: https://www.aafp.org/dam/AAFP/documents/practice_management/COVID-19/resuming-care.pdf. Accessed: May 12, 2020.

4.    Garcia S, Albaghdadi MS, Meraj PM, et al. Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic [published online ahead of print, 2020 Apr 9]. J Am Coll Cardiol. 2020;S0735-1097(20)34913-5.

5.    American College of Emergency Physicians (ACEP). COVID-19. Available at: https://www.emergencyphysicians.org/globalassets/emphysicians/all-pdfs/acep-mc-covid19-april-poll-analysis.pdf. Accessed: May 25, 2020.

6.    Masroor S. Collateral damage of COVID-19 pandemic: Delayed medical care [published online ahead of print, 2020 May 17]. J Card Surg. 2020;10.1111/jocs.14638.