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Eighty percent of primary care clinicians say they continue to limit well and chronic care visits at their practices for COVID-19-related reasons, according to a survey conducted April 24-27 by the Primary Care Collaborative and The Larry A. Green Center. Many practices have shifted these “non-essential” visits to telehealth or telephone visits until they can safely resume them face-to-face.
The decision to reopen a practice for in-person visits depends on many factors, including the availability of personal protective equipment, the availability of COVID-19 testing, and the prevalence of COVID-19 cases in your area.
When your practice decides to reopen, the following checklist can help ease the process and keep everyone safe.
• Gradual 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 will allow you to assess how things are going and then gradually and safely expand access.
• Patient communication: Let patients know when the practice will reopen and how visits will be different than in the past. Assure them that you are taking all recommended precautions to protect their health and safety.
• Staff shifts/teams: If possible, divide staff up into shifts or teams. If one team gets exposed, the other teams will be protected.
• Scheduling and triage: Staff who schedule patients should evaluate the necessity of a face-to-face visit. Priority should be given to patients who need complex chronic care management and patients with illness. Preventive care may also be necessary, depending on the individual patient’s needs.
• Physical distancing: Staff and patients should practice physical distancing, staying at least six feet from one another unless closer content is required for patient care.
• Screening: Upon arrival, patients should be screened for respiratory symptoms and have their temperature checked. Consider greeting patients outside for these checks or use triage stations. Staff should check their own temperature before shifts.
• 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 area within the practice or by time of day. 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 others.
• Personal protective equipment (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 facemasks, gowns, eye protection, and gloves when caring for patients with suspected COVID-19. Facemasks and gloves are recommended when treating non-ill patients as well because of concerns about asymptomatic COVID-19 patients.
• 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 Centers for Disease Control and Prevention (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, will help cut down on the need to sterilize these surfaces.
Adapted from the AAFP resource Considerations on Re-opening Your Practice and CDC guidance for ambulatory care settings.
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