Post-COVID practice procedure and policy updates

Ada Stewart-MD, FAAFP, president-elect, American Academy of Family Physicians (AAFP), Leawood, Kan.-ticks off the enhanced infection control (IC) efforts at her practice as a result of COVID-19.

“We removed chairs to make sure people were six feet apart. We schedule sick visits one half of the day and well visits the other half. We removed magazines from our waiting rooms and clean rooms after patients leave, wiping down things before and after. Because of coronavirus, we constantly wipe down doorknobs and anything a patient touches,” explains Stewart, lead provider and HIV specialist at Cooperative Health, Columbia, S.C.

The AAFP “Checklist to Prepare Physician Offices for COVID-19” advises clinicians to review medical cleaning and disinfection routines for SARS-CoV-2. Other tips to reduce germ exposure include use of hand sanitizer, respirators, face shields, goggles, surgical masks and gowns for caregivers or staff as well as adherence to guidelines from the Centers for Disease Control and Protection (CDC), Atlanta, it states.

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“We always implemented hand-washing and other CDC practices, but our IC practices have increased 100 percent. We make sure employees are well, wear masks and constantly use hand sanitizer. I give samples of hand sanitizers to our patients who don’t have them at home,” says Stewart.

Rick Gundling-FHFMA, CMA, senior vice president, healthcare financial practices, Healthcare Financial Management Association, Westchester, Ill.-says “physicians might want to consider taking a quick temperature. Have a generous cancelation policy. If you wake up and you’re not feeling good, take your temperature at home. Don’t drive to my office for us to take it,” he suggests.

Indeed, Stewart says, “When they (patients) walk in our office, we take their temperatures. Even employees have their temperatures checked. Employees sign in everyday to make sure they don’t have symptoms. That was not done prior,” she comments.

AAFP’s “COVID-19: Guidance for Family Physicians on Preventive and Non-Urgent Care” recommends use of telehealth, virtual or e-visits for routine, chronic and preventive visits until the virus subsides. Physicians should base their strategy on need, circumstance and patient and staff safety, it states.

“We offer telehealth and telephone visits, but because of the population I see that doesn’t work well. Many of my patients don’t have phones or they have phones with limited minutes,” says Stewart.

Adds Gundling, “There’s only so many things you can do via telehealth. Eventually, you have to see and touch patients. You can’t do urine analysis over the phone,” observes Gundling who expects IC practices, made in response to COVID-19, to “start moderating once we learn what works and doesn’t work.

“Maybe it’s a weak virus or doesn’t stay as long as we thought. So chairs only have to be sprayed down once a week, not every day. I picked up a bottle of Lysol the other day and it specifically said, it kills the H1N1 virus. I’m sure they’ll update that for coronavirus,” he notes.

However, Stewart expects these practices to continue indefinitely. “It’s hard to go back to the way things were,” says Stewart who notes how she and her patients struggle to adjust to the new normal.

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“When I walk into the (exam) room, I’m wearing a mask. I was one of those doctors who was a hugger. Any patient who came in the office got a hug. Now we do the elbow. That’s been really difficult for me and my patients,” she says. 

Gundling says physicians should “do a cost-benefit analysis to make sure your patients feel comfortable. Use the best guidelines from the CDC and look at your patient population. If they tend to be elderly and vulnerable to coronavirus, you might want to be careful and demonstrative about your effort. Let them know you spray your office with disinfectant.

“Part of it is to make the patient feel comfortable. You might want to put out information about how we’re protecting you. We’re going to clean all common spaces. We wipe the doorknobs. Those kinds of things,” he says.

Stewart stresses the importance of communication and preserving the doctor-patient relationship. “You want to make sure that, when patients walk in, it’s a safe environment. You’d be surprised how many patients want to make sure you’re well. They care about their doctors,” she says.