As lockdown lifts, medical practices reopen
We recently spoke with three healthcare organizations about the safety protocols and workflow changes they are putting in place to re-open and stay open.
Contact-free scheduling and check-in
During the pandemic, practices have been reevaluating their pre-visit procedures, minimizing face-to-face contact. The majority of practices have shifted to self-scheduling and online check-in.
According to Misha Moore, Ph.D., of Green Tree Pediatrics in Chelsea, Michigan, it was all about “controlling the flow of people in and out of the offices, and limiting how much time people were spending in the office.” To that end, Green Tree moved to an entirely online check-in process, including screening for COVID-19 risk and for depression, a key concern in this stressful time.
At DTC Family Health in Greenwood Village, Colorado, patients are filling out their paperwork online, and staff are calling patients the day before their visit to screen for signs and symptoms of COVID-19.
And everyone is limiting the time patients spend in waiting rooms, with many practices asking patients to wait in their cars until called. “We have a large waiting room and are able to keep patients 10 feet apart,” says Lynn Joffe, M.D., of DTC, “and are wiping down the chairs between patients.” When patients are called by the front desk, their temperature is taken and they are again asked COVID-19 risk-screening questions — only then are they taken back to the exam room.
All sick visits begin as telehealth visits and, if the patient needs to come in, staff is ready with personal protective equipment (PPE) and appropriate safety protocols.
New workflows for surgical procedures
One of the most complicated parts of reopening post-pandemic is the resumption of elective surgery.
The first step is to determine which patients should even have surgery. “The biggest thing is looking at risk stratification for our patients,” says Krista Eylar, director of nursing at Holton Community Hospital in Holton, Kansas. “We are prioritizing our patients based on urgency, but also balancing risks and benefits, especially for elderly patients.”
And, as with ambulatory care, scheduling and registration have gone virtual, with a combination of online and phone registration, which includes COVID-19 risk screening. Additionally, at Holton, all surgical patients are tested for COVID-19 three days before their procedure and are asked to quarantine until their visit. “The goal is to do as much as possible in advance, so on the day of we can just focus on care delivery,” says Cody Utz, director of patient care services and quality at Holton.
To minimize time in the facility, at Holton they are being extra careful to make sure that any required lab tests are conducted before the patient arrives – and they are relying heavily on tools within the EHR to coordinate between surgery and ancillary areas. And whenever possible, pre-op and post-op visits are being done through telehealth.
Holton is following strict airborne safety protocols for all endoscopic procedures and is still not allowing any visitors for surgical patients. And they are scheduling extra time between procedures to let staff safely get in and out of PPE. They even added an additional staff member whose job it is to monitor providers’ PPE during procedures. “We can’t afford to lose any of our surgical resources,” says Eylar, “so protecting them has been one of the most important things.”
Staying up to date on best practices
In the ever-changing world of COVID-19, new research and guidelines are coming out all the time. Practices who want to reopen — and stay open — are making a point to stay current.
According to Moore, “the most important thing you can do is to keep your world big and make sure that you are relying on credible sources and data.” That means closely following updates from the CDC, medical societies, and state health departments.
The next step is to communicate proactively with staff whenever a guideline has changed and make it clear how this will impact clinical and administrative workflows.
And many practices are participating in forums designed to facilitate discussion between providers so they can share their learning and insights. As Moore says, “Relying on credible data and talking to each other is how we are going to get through this.”
Proactively communicating with patients
Patients are understandably nervous about coming into a medical office, so communication right now has to go beyond automated reminders and emails — patients need to be reassured.
As they reopen to more routine care, practices are taking advantage of patient outreach tools to communicate with patients and explain safety measures, including reminding them that telehealth is still an option. Moore shares, “We use our automated campaigns — email, text, phone – and we can customize the message to let patients know it’s safe and it’s time to come in.”
Mindful of the need to continue preventive care, especially vaccines, practices are specifically targeting patients who most need to be seen. Reports from the EHR by age, diagnosis, and last visit date drive patient outreach. “We cannot sit back and wait for that phone to ring,” says Moore. “We have to reach out to them.”
More generally, practices are regularly communicating with all patients about COVID-19. “We are sending weekly emails updating patients on the status of current knowledge and how that impacts our practice,” says Joffe.
At Holton, in addition to automated outreach campaigns and emails, Jenea Chartier, clinical information systems security officer at Holton, shares that Facebook is one of their most effective tools for patient communication. They link to resources, share advice on how to stay safe, and have even uploaded a video on how to properly put on a mask.
Staying flexible and practical
One of the most difficult aspects of this pandemic is how quickly information is changing. As Eylar puts it, “right now, we are all in a learning process.”
Adapting quickly is one of the greatest assets to practices as they reopen — and doing so in a way that makes common sense. At DTC, Joffe shares, providers were initially using gloves in all encounters, but they were touching so many things in the course of a visit, they had to change them three or four times. “Handwashing or sanitizer was much more practical, so we changed.”
Another suggestion for staying adaptable is to be prepared to fill in for staff absences, and have a protocol in place to quickly transfer patients to isolation if they come in and screen as high risk for COVID-19. At DTC the staff huddles every morning to review any protocol changes, confirm that everyone on the schedule is safe to come in, and hear suggestions from the team.
Staff are being asked to change so much right now, “gaining their perspectives and insights, checking in regularly, listening to their concerns has really helped us get their buy-in,” advises Utz.
“Patient care during COVID-19 pandemic is a completely moving target,” says Joffe. “The most important thing is just to be incredibly flexible.”
Lia Novotny is a contributing editor to athenahealth's Knowledge Hub.
To hear more from Misha Moore, Ph.D, Lynn Joffe, M.D., Krista Eylar, Jenea Chartier, and Cody Utz, watch the webinar.