As increasing numbers of patients contact physicians’ offices to report symptoms of coronavirus disease 2019 (COVID-19) or other respiratory infection, such as fever and cough, practices are needing to adapt their patient triage, scheduling, and rooming workflows to minimize exposure to respiratory pathogens. Based on current guidance from the Centers for Disease Control and Prevention, here are three workflow changes to consider for symptomatic patients.
1. Use nurse-directed triage protocols to determine if an appointment is necessary. In general, if the patient’s symptoms of COVID-19 or other respiratory infection are mild, the patient can be managed from home. If symptoms are severe (e.g., difficult breathing), the patient should be sent immediately to the emergency department or hospital, and your practice should notify the facility. Patients with moderate symptoms are the ones most likely to need evaluation in the primary care setting.
2. For patients who need to be evaluated, consider offering a telehealth visit as an alternative to a face-to-face visit. CMS has loosened the guidelines around Medicare telehealth visits, allowing physicians and patients to use widely available technology, such as Facetime or Skype on a smartphone, for these visits. For more information, see the recent FPM blog post on the relaxed telehealth rules and the AAFP's new telehealth guide.
3. If patients must come in for an office evaluation, have them skip the check-in desk. A designated nurse or other clinical staff member should meet the patient at the entrance (or a separate side entrance if possible), mask the patient, and escort the patient to a designated exam room. If an exam room is not readily available, escort the patient to a “sick” waiting area — a separate, well-ventilated space that allows waiting patients to be separated by six or more feet, with easy access to respiratory hygiene supplies. Patients could also opt to wait in their cars or outside the practice and be contacted by mobile phone when it is their turn to be seen.
For information about evaluation, testing, and treatment, see the CDC’s guidance “Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19).”
What changes have been effective in your practice? Share your tips by commenting below.
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