Zulfiqar Rana, MD, MPH, FACP
Board Certified in Internal Medicine
COVID 19 Outpatient Clinics
March 21, 2020Posted by on
This article is addressed to healthcare workers in the outpatient setting.
COVID-19 Guidelines for outpatient clinics.
The article is for providers, office managers, and nurses.
Focus is prevention (treatments are considered elsewhere).
Most of the info is from CDC.gov
Communication is the key (CDC)
- Communicate about COVID-19 with your staff.
What to do?
- Share information about what is currently known about COVID-19, through meetings, email, and texts, etc
- discuss the potential for surge, and action plan
- your facility’s preparedness plans including what to do if it needs to shut down
- Daily Huddles if needed.
- Communicate about COVID-19 with your patients. Provide updates about changes to your policies regarding appointments, providing non-urgent patient care by telephone, and visitors.
What to do? Communication modes?
- Website announcements e.g., Anniston Medical Clinic
- Facebook Page e.g., AMC on Facebook
- Phone messages/ greetings
- Direct Communication with patients
Protecting Your Employees (CDC)
- Screen patients and visitors for symptoms of acute respiratory illness (e.g., fever, cough, difficulty breathing) before entering your healthcare facility.
Remember to keep up to date on the recommendations for preventing the spread of COVID-19 on CDC’s website.
Options to screen (most strict to least strict)
- Shut down the facility e.g., a private practice in Pell City
- No sick patients to visit the clinic e.g., some private practices implementing that.
- Front door screenings with thermal scans and questionnaires, entrance posters and limiting visitors e.g., ERs and RMC
- Front desk / triage
- Waiting room posters
- Limit number of visitors to one or two
- Discharge patients immediately after seeing them. Call them later with an appointment if that is an option
- Ensure proper use of personal protection equipment (PPE). Healthcare personnel who come in close contact with confirmed or possible patients with COVID-19 should wear the appropriate personal protective equipment.
- Asymptomatic individuals without COVID-19 exposure – STANDARD PRECAUTIONS
- Asymptomatic individuals WITH COVID-19 exposure – PPE (glove, gown, N95)
- Mild or non-specific symptoms (sore throat, myalgia, fatigue, nausea, and diarrhea) with or without fever – still use PPE
- Release of COVID-19 patientsALL of the following:
- The patient is free from fever without the use of fever-reducing medications.
- The patient is no longer showing symptoms, including cough.
- The patient has tested negative on at least two consecutive respiratory specimens collected at least 24 hours apart.
Someone who has been released from isolation is not considered to pose a risk of infection to others.
- COVID-19 confirmed – PPE
- Conduct an inventory of available PPE. Consider conducting an inventory of available PPE supplies. Explore strategies to optimize PPE supplies.
Use of PPE somewhat controversial and confusing
- Encourage sick employees to stay home.
- Employees check Temp (cut off 100) and symptoms of cough or SOB
- Personnel who develop respiratory symptoms (e.g., cough, shortness of breath) should be instructed not to report to work.
- Ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies.
Protecting Your Patients (CDC)
- Stay up-to-date on the best ways to manage patients with COVID-19.
Johns Hopkins Coronavirus Resource Center gives the best up-to-date case numbers.
- Separate patients with respiratory symptoms so they are not waiting among other patients seeking care.
Identify a separate, well-ventilated space that allows waiting patients and visitors to be separated.
- Consider the strategies to prevent patients who can be cared for at home from coming to your facility potentially exposing themselves or others to germs, like:
- Using your telephone system to deliver messages to incoming callers about when to seek medical care at your facility, when to seek emergency care, and where to go for information about caring for a person with COVID at home.
- Adjusting your hours of operation to include telephone triage and follow-up of patients during a community outbreak.
- Leveraging telemedicine technologies and self-assessment tools.
Updates on Telemedicine
Please refer to our section on telemedicine
Appendix I – Table I
Persistence of coronaviruses on different types of inanimate surfaces
View Table in PDF PIIS0195670120300463
MERS = Middle East Respiratory Syndrome; HCoV = human coronavirus; TGEV = transmissible gastroenteritis virus; MHV = mouse hepatitis virus; SARS = Severe Acute Respiratory Syndrome; RT = room temperature.
Appendix II – diagnosing patients
According to CDC,
“Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Most patients with confirmed COVID-19 have developed fever1 and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Priorities for testing may include:
- Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.
- Other symptomatic individuals such as, older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).
- Any persons including healthcare personnel2, who within 14 days of symptom onset had close contact3 with a suspect or laboratory-confirmed4 COVID-19 patient, or who have a history of travel from affected geographic areas5 (see below) within 14 days of their symptom onset.
There are epidemiologic factors that may also help guide decisions about COVID-19 testing. Documented COVID-19 infections in a jurisdiction and known community transmission may contribute to an epidemiologic risk assessment to inform testing decisions. Clinicians are strongly encouraged to test for other causes of respiratory illness (e.g., influenza).”
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