As the daily number of new COVID-19 cases in the U.S. nears 200,000, and the CDC has urged Americans not to travel for Thanksgiving, we’re in for a potentially difficult time this winter. According to Johns Hopkins University’s global COVID-19 dashboard, the U.S. now has nearly 12.5 million cases, more than any other country in the world, with numbers increasing in both rural and urban areas.
In an effort to keep further spread under control, states are imposing new restrictions and guidelines, from stricter mask mandates and reduced restaurant capacity to limiting the number of people permitted to gather indoors.
In New York, new curfews have been established and, as with other states, entry into the state requires a 14-day quarantine after or proof of a negative COVID-19 test. In North Dakota, increased hospitalizations and a lack of healthcare workers have led to new laws allowing asymptomatic healthcare workers who have tested positive to treat other COVID-19 patients. Will some states or municipalities close businesses and reinstate lockdowns? Only time will tell.
AMA guidance on keeping healthcare practices open
Assuming the current trajectory continues into the near future until cities can flatten the curve again, medical and dental practices will need to work diligently to stay open throughout the winter.
This spring, the American Medical Association (AMA) produced guidance to help reopen practices. Now, the AMA has updated those existing guidelines with several additional tips to help practices remain open during this next stage of COVID-19.
The revised AMA guide expands on previous tips such as complying with local government guidance, screening employees and patients, and reviewing your medical liability coverage.
As you prepare your practice to stay open this winter and continue delivering care to patients, here is a summary of some of the AMA’s detailed tips:
1. Plan for supplies in advance.
The AMA recommends assessing PPE levels regularly and ordering in advance, operating under the assumption that shipments may be delayed. Having an adequate supply on-hand of everything you need will ensure you can keep your doors open.
2. Prepare for exposures.
At this point, COVID-19 is widespread enough that exposure has become increasingly likely. All practices should have plans for handling contact tracing, staffing, and cleaning. These should be applicable whether the exposure originates from an employee, a patient, or a visitor (Practices should be limiting all visitors as much as possible, anyway. See tip #4 below.)
Ensure your practice and return-to-work policies are aligned with the latest guidance from the CDC. If a practice employee contracts COVID-19 while at work, follow CDC and your local public health protocols regarding steps for notification, quarantine, and communication.
3. Focus on safety measures.
The AMA guide encourages adjusting your schedule to limit patient volume and density; maintaining separate waiting areas for sick and well patients; and more obvious tips like requiring patients to wear masks and explaining mask policies ahead of time. Other recommendations include having patients wait in their cars to reduce waiting room volumes, and allowing additional time in between appointments for cleaning.
For staff safety, the guide recommends procedures that most practices already have in place such as screening employees for symptoms and communicating policies about not reporting to work if symptoms are present. The AMA also encourages rearranging workstations to increase physical distance, and minimizing the number of people touching equipment by setting up dedicated workstations and patient rooms for staff.
4. Limit visitation.
While most practices already minimize the number of people entering their office, it may be time to consider tightening up visitation policies — especially if cases are on the rise in your local area. Be sure to communicate your policies clearly and post them visibly at all points of entry. To eliminate any confusion or frustration, educate your staff and discuss when and if any exceptions to the policy should be made. For vendors, deliveries, or maintenance work, consider establishing a consistent window of time outside of office hours to reduce interaction with patients and staff.
5. Triage appropriately.
The AMA recommends using telehealth to triage patients, to ensure they are given proper guidance based on their conditions and symptoms. This allows for patients to be referred for COVID-19 testing, if appropriate, while others have the option of a telehealth visit instead of an office visit. This teletriage approach limits office occupancy and saves in-office appointments for those who truly need to be seen in person.
6. Remember confidentiality guidelines.
The AMA reminds practices to develop, or update privacy and confidentiality protocols. This is particularly important as it relates to employee screenings and COVID-19 test results. Remember that you can alert employees and patients if they came into contact with someone who tested positive for COVID-19, but the identity of the person, and details about their symptoms or condition can’t be shared without consent.
7. Coordinate testing.
Identify numerous testing centers near your office. Stay up-to-date on their test offerings (PCR, rapid, antibody) and turnaround times, and communicate this information to your patients as needed. Depending on the nature of your practice, you may want to require pre-procedural COVID-19 testing for patients undergoing a procedure, to ensure proper isolation.
The AMA also has a comprehensive COVID-19 resource center for medical practices, which they update regularly as new information is issued by the CDC, WHO and other organizations. Practices can download a full PDF of the guide.
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