• Considerations for Resuming In Person Care

    As states ease physical distancing restrictions related to COVID-19, practices are reopening or adopting a phased reopening strategy. But conflicting information is making the process more difficult.

    Updated 9/15/20

    The decision to reopen depends on many factors, from the availability of personal protective equipment (PPE) and testing to the prevalence of COVID-19 cases. Practices should also be mindful of, and prepared for, the potential for a resurgence. 

    This guidance on reopening for face-to-face visits is meant to help you weigh decisions about your practice operations. The AAFP will update the guidance and offer resources as more evidence becomes available.

    Comment on Reopening Schools 

    As conversations increase around schools reopening late this summer, AAFP President Gary LeRoy, M.D. shares this comment to help members prepare their practices, and communicate with their patients and community. 

    “Family physicians understand the importance of in-person learning for children. They also understand the potential health risks of sending children back to school during a national pandemic. As we look to the 2020 school year, it will be important to monitor the number of COVID-19 cases in individual cities and communities to help signal if and when the risks of attending school begin to outweigh the benefits. Return-to-school guidelines should be evidence-based and flexible in response to new information, as we are still learning how COVID-19 spreads and cannot predict where the next outbreak will appear. For this reason, even as schools implement new disinfecting protocols, we must remain vigilant about hand washing, face masks and practicing physical distancing.”

    Checklist to Support Reopening and Promote Safety 

    Use this information when your practice decides to begin seeing patients in person or increase frequency of in person visits.

    Patient communication: Patients without COVID-19 symptoms may have hesitation or fear about visiting any health care facility, especially when cases are increasing. Consider how to help your patients regain comfort in visiting your practice. Plan communications to your patient population to help them feel safe and let them know how visits will be different.

    1. Use your practice website or social media to share updates and reassure your focus on their safety.
    2. Remind your patients to call the office to discuss their concerns before canceling appointments.
    3. Assure patients you are taking all recommended precautions to protect their health.

    Gradual reopening: Many practices have been conducting visits via telehealth. When reopening, consider opening up just one-third of your time to in person visits and keep two-thirds as virtual visits for a while. This allows you to assess how things are going, then gradually and safely expand access.

    If your practice is already fully open, continue to offer telehealth as an option for those patients who do not feel comfortable with a face-to-face encounter. A new AAFP Telehealth Toolkit offers you steps for navigating scenarios when you implement or expand your telehealth program.

    It's essential that patients are seen in-person for visits where immunizations need to be administered. Share that a delay in these immunizations can put the patient and others at risk for other preventable diseases.  

    Staff shifts/teams: Divide staff up into shifts or teams if possible. If one team is exposed, the other teams will be protected.

    Scheduling and triage*: Staff who schedule patients should evaluate the necessity of a face-to-face visit. The CDC developed a guide for phone calls with patients that includes scripts, decision algorithms, and tailored care messages. *Priority should be given to patients who need immunizations and complex chronic care management, and patients with illness.

    Preventive care may also be necessary, depending on the individual patient’s needs. When calling patients with appointment reminders, staff should screen patients for symptoms of COVID-19 during the call, prior to patients visiting the office.

    Physical distancing: Staff and patients should practice physical distancing, staying at least six feet from one another unless closer contact is required for patient care. Try to limit the number of staff in a patient room at one time to reduce exposure risks.

    Screening: Staff should check their own temperature before shifts. Upon arrival, patients and those accompanying patients should be screened for respiratory symptoms and have their temperature checked. Limit excess visitors to office visits and consider communicating with care partners telephonically if appropriate. Consider greeting patients outside for these checks or use triage stations. View the CDC guidance for ambulatory settings.

    If your clinic does not have testing capacity, partner with your local health department to ensure testing is available to patients.

    Common areas: The staff break room, patient waiting room, and other common areas where individuals are in close proximity should all stay closed if possible. Consider escorting patients directly to an exam room upon arrival or have them wait in their cars or in triage stations until called in for their appointment.

    Patient separation: Separate well and sick patients either by entrances, by area within the practice, by time of day, or a combination. Healthy patients without respiratory symptoms should be assigned to regular exam rooms. Patients with respiratory symptoms can be treated via telehealth, in their cars, or in designated exam rooms separate from the other patients.

    PPE: Require all patients and staff to wear masks regardless of the reason for the visit. Patients may wear their own cloth face coverings. Clinical staff should wear masks, gowns, eye protection and gloves when caring for patients with suspected COVID-19.

    Follow the recommendations of your local health department regarding use of PPE in non-ill patient care. View additional guidance from the CDC and new guidance from OSHA.

    Hand hygiene: Ensure that hand hygiene supplies are readily available to patients and staff. Staff should perform hand hygiene before and after all patient contact, after contact with potentially infectious material, and before putting on and after removing PPE, including gloves.

    Sanitation procedures: Exam rooms should be cleaned and disinfected per CDC guidance after each patient. Disinfect frequently touched surfaces such as doorknobs and light switches at least daily. Limiting the surfaces that staff and patients must touch, by propping doors open or using automatic door openers, can cut down on the need to sterilize these surfaces.

    Pregnancy considerations for staff: As medical offices resume more in person care, questions for physicians and their staff who are, or could be, pregnant arise. Find answers to some of the frequently asked questions regarding work accommodations, paid or unpaid time off, discrimination, etc in this document compiled by A Better Balance "KNOW YOUR RIGHTS: Pregnancy, Workplace Rights, & COVID-19 FAQ."

    For Residents, the AAFP has the Parental Leave During Residency policy

    The CDC offers printable physician resources to support practice operations and patient education.