Many physician practices throughout the U.S. are starting to see the impact of the coronavirus.
As the highly contagious virus is only likely to spread in the weeks ahead, now is the time for leaders to prepare for how they will help diagnose and treat patients and keep their practices running, says Debra A. Cooper, R.N., a senior risk management specialist with Coverys, a medical liability insurer.
Start planning now for when a patient presents at your practice with symptoms of this novel virus, Cooper said in an interview with FierceHealthcare. She has spent much of her career preventing, treating and educating healthcare organizations about infectious diseases,
“The biggest thing is communication and knowledge,” she says.
Practices that are affiliated with a hospital or healthcare system may have an advantage, as they can piggyback off their efforts to prepare for coronavirus and get some guidance from them.
Independent practices may have to work harder to create their own plan, she says.
“The best thing they can do is just to prepare,” Cooper says, as luckily most areas of the United States have not seen the kind of outbreak that occurred in China, where the pandemic began. However, health experts say the outbreak in the U.S. will be worse before it gets better.
Hospitals are looking at interim guidelines from the Centers for Disease Control and Prevention (CDC), but many of those guidelines don’t relate to a physician's office, she says.
So, where to begin? Here are six recommendations to follow:
Have a plan to identify patients who may have COVID-19 or be at risk for the virus. Practices should develop triage questions for their employees to use to recognize patients infected with the virus, she says.
You will want to modify your existing triage questions for staff to use when patients call your practice. Have a standard script for the staff in your office who answer the phone.
They will want to ask patients if they have traveled to any geographic location in the last 14 days where there is widespread ongoing transmission of the virus. The list of countries is growing. The virus that originated in Wuhan, China is now widespread in Italy, South Korea, Iran and is spreading in other European countries. So-called “hot spots” in the U.S., where the virus has spread, include Washington state, California and New York.
Ask patients if they have had contact with a person who has tested positive for coronavirus or is suspected of having the virus. Have they been caring for someone with the virus?
Ask patients about their symptoms. Do they have respiratory symptoms, a cough, a fever, shortness of breath?
If patients are at risk of having coronavirus, they will need to get tested. There has been a shortage of coronavirus test kits, but the government says more will be available.
Be aware of the designated testing facilities in your area, including hospital emergency rooms. Some communities have set up drive-up testing facilities. Before you send a patient to the hospital for testing, your office will want to call and alert them a patient with coronavirus symptoms is on the way, Cooper says.
The CDC does have a healthcare professional preparedness checklist for the arrival of patients with confirmed or possible coronavirus.
Be ready for patients who may come to your practice without an appointment. In that case, your staff will have not been able to screen patients to determine if they are at risk of coronavirus. It may be beneficial to post signs at entrances to your practice advising patients that they need to call the office to answer some basic questions associated with the risk of COVID-19 if they don’t have a pre-scheduled appointment.
Include on that notice that they call the office from their vehicle in the parking lot or from outside the office to answer basic questions to determine their risk before entering the office.
For patients who are at risk, you will want to take precautions when they come into your practice.
“This is where the choice of the physician may change,” Cooper says. You will want to make masks available and take any patient at-risk to a private room. You don’t want them to expose other patients or staff members.
If you have a negative pressure room, that will prevent the spread of germs in your facility. Cooper says she has heard of practices creating a negative pressure room by opening a window and placing a fan so it draws the air outside the building rather than letting it circulate to other areas where it could expose other patients or healthcare staff to the virus.
Plan ahead with local hospitals. Even if your practice is not affiliated directly with a hospital, practices will have relationships that they have developed. Get into communication with facilities in your area about what to do, including if you are in a rural area without a nearby hospital.
“The biggest thing is preparation. Where are our resources? Who can we depend on?” Cooper says.
Practices should also keep in mind their responsibility to notify their local or state public health department if they have a high-risk patient. Have all of those processes in place, she says.
Follow good infection control practices. Remind staff of proper infection control procedures, including handwashing and appropriate use of personal protective equipment, including masks, gowns and gloves.
Since there are concerns about possible shortages of PPE, practices may want to take steps to control their supply. For instance, many hospitals are now locking up supplies of masks and dispensing them when requested by healthcare staff.
You will need to frequently clean high-touch areas using approved cleaning supplies, Cooper says since the virus can survive up to three days on plastic and metal surfaces.
The CDC has provided recommendations for environmental cleaning and disinfection, along with the EPA which has a list of approved products.
If you use an outside cleaning company, be sure they are aware of what’s recommended.
Plan for how your practice will keep running if you are short on staff. Communicate with staff about your practice’s policies and procedures when it comes to illness. Employees who are sick must not come to work.
Plan now for what you will do if some employees cannot come to work, she says. For a small practice, the loss of one or two employees could mean that half of their workforce is out, she says.
This is a real possibility as schools around the country close due to the coronavirus outbreak, leaving working parents scrambling to find child care.
Keep current on information. It is imperative that practice leaders stay up-to-date on the ever-evolving coronavirus pandemic. There is no shortage of news about the coronavirus, and the CDC provides information about the virus, Cooper says.