Ensuring the Safety of Patients and Staff During the COVID-19 Pandemic

Medical practices entered a strange new world of patient safety requirements during the COVID-19 pandemic, and life will never again be the same. Regardless of size or specialty, all medical practices face significant challenges to protect their patients, community, and staff by reducing the risk of spreading the COVID-19 virus, while simultaneously maintaining their financial viability. Practice managers now need to lead their practices through changes and updates to their facilities (eg, plexiglass dividers and physical spacing), new demands and standards for the use of personal protective equipment (PPE) for staff and patients, enhanced cleaning, site-of-service transitions, new policies and procedures for onsite and remote office work, and high levels of expectations and concerns. Penalties for unmitigated exposure and failure to follow state and federal guidelines for safely opening and operating, including closure, need to be acknowledged as well. But more importantly, staff or patient concerns that may be expressed publicly (or by simply leaving), causing disruption to the operations and financial stability of the practice, need to be recognized and openly discussed.

Support Is Available

Many resources to support medical practices in their quest for this new world of safety exist; these include guidance from state health departments; the Centers for Disease Control and Prevention (CDC); professional medical societies, including the Medical Group Management Association (MGMA); and specialty societies such as the American College of Rheumatology (ACR) and the National Organization of Rheumatology Managers (NORM). Most practices find it easiest to begin with CDC guidance and then expand or personalize the safety steps to meet the needs of their own patient population, as well as the individual requirements of their specific state, should they differ.

Guidance from the CDC

The CDC recommends that medical practices basically follow the same measures that would be established to prepare for the influenza season. Resources and tools related to the management of and communications with healthcare workers, patients, and facilities associated with COVID-19 may be accessed at the CDC Practice Coronavirus Disease 2019 website (www.cdc.gov/coronavirus/2019-ncov/hcp/preparedness-resources.html).

The CDC guidance is divided into several useful sections, which provide many checklists and steps. The section titled “Getting Your Clinic Ready for Coronavirus Disease 2019” (www.cdc.gov/coronavirus/2019-ncov/hcp/clinic-preparedness.html) offers several useful suggestions regarding what to consider and do before patients arrive, when they arrive, and after they have been evaluated.

Examples of some of the CDC’s suggestions for preparing medical practices for patient care during the COVID-19 pandemic include the following:

• Prepare and plan to receive patients under the new parameters. Review patients’ information and consider whether it may be appropriate to transfer their planned appointment to a virtual platform; set up in-office visit alternatives, such as drive-up blood draws or injections; identify local health department communications and testing parameters; plan for COVID-19 testing and temperature checks for all staff and patients entering the practice; access and store needed PPE, cleaning, and other supplies for timely utilization; remove or clean toys, reading materials, and other communal objects; provide cleaning and sanitizing stations throughout the facility for both staff and patients; clarify new cleaning policies, products, frequencies, and procedures; and perform cleaning and disinfecting throughout the day
• When patients and staff arrive. Create an assessment protocol; ask about symptoms and potential exposure to COVID-19 since patients were last in the office; require or provide masks for symptomatic patients (or for all individuals, depending on local health requirements); separate patients prior to care either inside, outside, or in their cars; establish protocols for sick or symptomatic staff that separate them from other staff members and patients, and send them home under an established practice quarantine policy
• When patients are assessed and/or treated for reasons that brought them into the office. Plan on extra time (approximately 10 additional minutes) to ask patients how they are faring during the pandemic. This can yield valuable information, and offer the opportunity for guidance, counseling, and understanding of issues that may affect their medical condition, as well as their mental health status; provide written information on managing COVID-19 in patients’ homes and in their lives, taking into consideration their individual medical/mental health issues; plan for additional care in alternative settings and with the use of alternate methods; and clean and sanitize all common surfaces before the next patient enters the treatment space.

In addition to communication, education, and reassurance of patients, important physical facility controls and modifications are available that can support social distancing. The specific CDC recommendations for infection control are readily available at the following website: www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html.

Examples of some CDC suggestions for safe distancing and actions that practices are now undertaking to implement these recommendations include the following:

• Limiting visitors allowed inside the practice to those who are essential for the patient. Encourage alternative interaction options, such as video or conference calls, to include the patient’s loved ones and caregivers
• Reducing appointments to decrease patient volume in the waiting room and central areas. Expand office hours to evenings and weekends to manage possible patient backlogs and transition, where possible, to telehealth visits instead of in-person appointments
• Six-foot distancing in central areas and potential areas of congestion. Tape markings at the entrance lobby, in the waiting room, and at counters, and remove and/or arrange the chairs in the waiting area to achieve appropriate distancing
• Modification of group healthcare activities to incorporate safe distancing. Move to larger rooms to provide appropriate spacing, transition to conference calls and Zoom-type video call formats, or reduce the size of the group to allow for safe distancing
• Use of protective barriers, including appropriate PPE and physical barriers, to protect transmission from infected individuals. Require masks for all staff and patients (providing them when needed); physical indicators and signage demarking triage pathways, dedicated entry, and exit points to and through the facility; and physical barriers at points of contact between individuals (ie, plexiglass barriers mounted at counters/workspaces and between individuals in front of and behind the counters/workspaces)
• Optimized use of engineering controls and indoor air quality. For patients with compromised immune systems or respiratory issues, enable outdoor assessment and triage, where possible, adding portable HEPA (high-efficiency particulate air) filtration units, when feasible, to augment air quality; transition appointments to telehealth, when possible, to reduce patient exposure

The ACR has published clinical guidance for the management of pediatric and adult patients with rheumatic diseases under COVID-19 (www.rheumatology.org/Practice-Quality/Clinical-Support/COVID-19-Guidance) and NORM published a special newsletter issue on COVID-19 for rheumatology practices (www.normgroup.org/wp-content/uploads/2020/04/COVID19-Issue-April.pdf). Other valuable resources for medical practices seeking guidance and advice on operations and practice management during a pandemic may be found at the MGMA website (www.mgma.com). Members may sign in and find resources, such as the “12 Steps for Keeping Your Medical Practice Running Amid COVID-19” by Andrew Hajde and Cristy Good, and other checklists for practice managers.

Conclusion

Traditional practice management concerns regarding revenue cycle, patient care, physician and staff concerns, and specialty operations and equipment have been exacerbated by patient volume and required changes during the COVID-19 pandemic. The additional layering of education, communication, guidance, new infection control policies and procedures, and the use of specialized PPE and supplies is a novel responsibility for medical practices.