Effective screening, triage, phone/telehealth/on-site management, patient education, and communication remain essential, but you may need to revise your plan with the evolution of the disease within your community. Revisit your emergency plan and adjust policies and procedures accordingly.
If your office has been closed for several weeks, you will need to prioritize care based on patient acuity. Using an established standardized tracking system, determine which patients require the most immediate follow-up for laboratory, diagnostic testing, and referrals. A systematic approach to test and diagnostic tracking will enhance patient care by ensuring that tests ordered are completed, results are received in a timely manner, and patient follow-up is initiated. Critical to patient safety, an effective review process will reduce the likelihood of missed results while reducing patient harm, improving quality, and possibly avoiding a liability claim.
Prior to opening your doors/seeing patients:
- Reconcile overdue patient appointments (including those cancelled due to office closure).
- Prioritize in-person visits according to medical priority/necessity. Keep in mind limited office capacity, need for physical distance, and risk level of patients. Route patients to telehealth visits when necessary.
- Reconcile telehealth appointments that occurred during office closure, including review of documentation for completeness. Consider developing a template specifically for use with telehealth encounters.
- Have staff conduct pre-visit patient training on connecting to telehealth prior to their initial appointment. Obtain all necessary documents and consent prior to the visit. This will provide for a smoother first encounter and save time.
- Utilize CDC guidelines for COVID-19 screening of patients when scheduling appointments. Document process. Triage (using licensed professionals) and manage patients according to presenting symptoms.
- When communicating the appointment reminder to patient, screen/document once again for COVID-19 symptoms.
- Conduct outreach to high-risk patients continuing to shelter-in-place to ensure adherence to pre-COVID-19 medical plan of care, assess current medication supply, and ensure knowledge of when to seek medical care for respiratory illness or otherwise. Suggest periodic use of the COVID-19 self-check assessment tool.
- For patients (or those with family members/significant others) who test positive for COVID-19, provide patient education on prevention, disease management, and medical disposition.
Phone Advice Line Tools (CDC)
Flowchart to Identify and Assess 2019 Novel Coronavirus (CDC)
Self-Check Tool (CDC)
What to Do If You Are Sick (CDC)
For patients arriving for on-site visits:
- Utilize CDC guidelines for patient COVID-19 screening on the day of appointment (e.g., taking of temperature, reviewing symptoms/contacts/travel, etc.) Document process. Manage suspected positive patients according to CDC guidelines.
- Advise patients to complete pre-appointment paperwork online prior to the appointment. Have patients notify staff by phone or text when they arrive for their visit. Advise patients to wait in the car, when possible, as an alternative to using the waiting room.
- Limit in-office visit to patients only. If the patient must be accompanied, screen that individual for COVID-19. Limit visitors to essential visitors only (one per patient if absolutely needed).
- Instruct all patients/essential visitors who enter your facility to wear a face mask, utilize tissues, practice good hand hygiene, and dispose properly of any contaminated protective equipment/tissues in a designated waste receptacle.
- Follow physical distancing and use different doors for entering and exiting.
Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19) (CDC)
Priorities for Testing Patients with Suspected COVID-19 Infection (CDC)
For children under the age of 2, the American Academy of Pediatrics does not recommend the use of masks.
For patient follow-up care:
- Prioritize reconciliation of outstanding clinical laboratory and diagnostic tests (tests ordered prior to the COVID-19 pandemic but not yet completed or report not yet received).
- Prioritize reconciliation of outstanding specialty consultations.
- Ensure specialists have a robust triage system to see high-needs patients first. Consider if a telehealth visit is appropriate for the patient in conjunction with the specialist.
- Confirm your specialist referral process includes all needed information, progress notes, test results, reason for visit with timeframe indicated—anything needed for the specialists to quickly and accurately evaluate need for visit.
- Consider positive clinical and diagnostic tests results as priority for notification and referral processing, if applicable.
- Prioritize medical and cardiac clearance for anticipated surgical volume increase.
- Prioritize prescription refills accordingly.
- Obtain an updated socioeconomic history from the patient. Assess whether the patient has experienced changes with any of the following: employment, finances, insurance, living arrangements, access to medications, transportation, etc.
- Conduct daily staff huddles and end-of-day debriefs. This provides all staff opportunities to discuss anticipated issues during the day and identify concerns pre- and post-clinic, including COVID-19 updates.
- Assess the need for providing emotional support to patients who may be dealing with fear or other stressors during this time.