Patient intake from a distance: 9 safety protocol recommendations for in-office visits

As the entire healthcare industry continues to manage and adapt to the COVID-19 pandemic, maintaining safety has been paramount. Whether you care for a higher-risk community during this time, or serve a general patient population, it’s important to implement updated procedures and protocols to keep your patients and staff safe — especially as you gradually increase your volume of in-office visits. 

Screenings and increased safety measures can go a long way to reassure and protect everyone as the situation evolves and patients return to in-person appointments. To help you meet that need, we’ve collected top tips shared by providers, as well as guidance from the AMA and CMS.

Some of these might seem obvious in the course of delivering care; others less so. Regardless, they are reminders of what’s needed to keep operations running smoothly, and your practice prepared for the potential unknown.

1. Screen every patient by phone. When a patient schedules an appointment, screen them to ensure they don’t have any symptoms of COVID-19. (If they do have symptoms, direct them to a designated COVID-19 testing facility). Call each patient on the day of their appointment to make sure they don’t have any new symptoms. It’s possible that a patient could wake up with symptoms and not tell you until they arrive at your practice, so that extra step is essential. You may not have the opportunity to call that first patient of the day, so check for any new symptoms when they arrive at your office. For appointments later in the day, call those patients to ensure nothing has changed.
2. Have patients wait in their car before their appointment. To minimize contact with others, ask patients to wait in their car until you’re ready to see them. Or, you can set up an area outside that’s covered from the elements. Then, call or text each patient when you’re ready to see them. Have them meet you at an office entrance and then screen them there again before they enter the office.

   If you do need to maintain a waiting area, as part of your operation or perhaps occasionally due to adverse weather, spread it out. Minimize seats and surfaces, and keep your numbers low so people can comfortably keep their distance from one another.

3. Take the temperature of every patient at your practice entryway door. As part of that screening, take each patient’s temperature at the door. Although you’ve already screened them over the phone, this helps eliminate whether they have COVID-19 symptoms.
4. Don’t allow patients to bring guests or have visitors. Ask patients to arrive at the appointment alone, unless they are being assisted by someone who will help facilitate care (the guest will need to be screened for COVID-19 symptoms, too). For pediatric visits, request that only one parent be present for the appointment.
5. Separate for safety.  Create an area to routinely screen staff for symptoms as well, and make sure your screening area is apart from the rest of your practice. This helps you immediately divert anyone that screens as being symptomatic. In addition, designate your NCC, or, “Non-COVID Care” zones, which can be entrances, rooms, or, depending on your practice size, an entire building.
6. Have all staff wear personal protective equipment (PPE). All practice staff should wear PPE. Ideally, see only one patient at a time, so your medical assistant can even manage intake from a distance. One practice we spoke with had their MA stand about 10 feet away in the hallway of their office while talking to the patient sitting in an exam room. If the MA needs to perform any procedures, they should wear a facemask and PPE.

   For any healthcare providers conducting procedures involving mucous membranes or that naturally carry a higher risk of transmission, use N95 masks or face shields.

7. Have designated exam rooms. When you walk each patient into your office, put them right into an exam room. They should enter alone and see no other patient along the way. When you have another patient arrive at your office, have the first patient in a separate, closed room. When you bring in the second patient, bring them to another side of your office, far away, without any cross contact.
8. Wipe down all surfaces with each visit. In the exam room, remove any extra furniture, and forego using paper on the tables. Instead, wipe and disinfect your tables after each appointment. Keep everything as clear and spare as possible, and limit contact.
9. Have patients exit out the office back door. If you have a back entrance, use it to have patients leave so they’re not walking through your office again and, preferably, not using the same entrance as incoming patients. You may need to rethink your office layout to accomplish this; a break room or back office may need to become your new, sanitized path to leave after an appointment.