As we enter the season for flu and other respiratory illnesses amid growing rates of COVID-19, many practices are making plans to meet patient demand while minimizing the transmission risk of the novel coronavirus and other pathogens. Outdoor patient care has become less feasible in many parts of the country as cold weather sets in, but there are several ways to increase safety while providing respiratory care within clinic buildings.
Managing patients outside of the clinic reduces in-person demand and minimizes crowding and infection risk. Triaging protocols for nurses can direct patients to home care or video visits when appropriate, especially for patients who are at higher risk of serious complications from the flu or COVID-19.
COVID-19 testing, ideally in a drive-through or parking lot site, is an essential resource to provide without bringing patients into the clinic space to add to crowding and infection risk. When patients come in for non-respiratory problems, but have respiratory symptoms, prompt testing can inform whether they can still be cared for normally in the clinic or if other precautions should be taken (but beware of false negatives). You can streamline the process of ordering testing by delegating it to nurses, and provide timelier reporting of results (which is important for isolation of infectious patients and triage of those who need more care) by centralizing the reporting process. Centralized reporting of test results can also ensure timely prescriptions for antiviral medications. As flu season progresses, multiplex testing that combines tests for COVID-19 and influenza can be helpful, and including rapid strep testing can remove another high-volume, in-person need from clinics.
For patients who require in-person care, physical spaces should ensure separation of those with respiratory illnesses from those without them. Entirely separate buildings would be best, but with appropriate precautions, ill and well patients can be seen in the same building. The key is to separate patients by either space or time, using parallel care or “end-of-day” scheduling. In parallel care models, patients with respiratory symptoms and those without are seen at the same time but use separate entryways and separate clinical care spaces. Separation needs to begin from the patient’s arrival in the parking lot through the end of the visit. Clinics that do not have a physical layout that can support this model can instead use “end-of-day” scheduling models in which well care shuts down at a certain time and the entire clinic converts to same-day care of patients with respiratory illness.
For both models, patients should be directed to call upon arrival so that clinical staff can meet them and immediately room them. Patients should be instructed to don a surgical mask upon arrival for added source control. You can reduce personal protective equipment (PPE) needs and transmission risk by registering patients and taking their histories remotely before the visit.
There is likely some risk of airborne spread of COVID-19, although the percentage of cases that stem from it is unclear. To optimally protect clinicians and staff, use enhanced droplet precautions. That means barrier masks for patients and, if available, Powered Air Purifying Respirator (PAPR) or N95 masks with face shields, as well as gowns and gloves, for clinicians and staff in direct contact with patients who are symptomatic or test positive for COVID-19.
With the above practices, physicians can continue to meet the needs of well patients while also caring for patients with respiratory symptoms.
— Matthew Swedlund, MD, and Sally Frings, MA, BSN, University of Wisconsin Health
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