To see patients as safely as possible, you will need to make a number of physical and administrative changes to your office, including: signage, scheduling, modification of physical assessments, and cleaning. As well, staff will need to be educated about the new policies and procedures.
The following should be considered as best practice:
- Comply with governmental/regulatory agency guidance.
- Expand in-person care slowly and incrementally
- Develop and implement a telephone triage program.
- Implement safety measures for patients, staff, and clinicians
- Screen patients before in-person visits.
Which services to resume first
While we recognize that physicians would like clear and specific direction on which services would be considered reasonable to resume, in reality it’s up to each individual physician to decide which services can be safely offered.
When deciding which services to re-introduce and when, consider the message from the Provincial Health Officer that was distributed by the College of Physicians and Surgeons of BC, and the following principles contained within it:
Proportionality: Measures taken should be proportionate to and commensurate with the real or anticipated risk one is trying to prevent.
The harm principle: Measures taken should attempt to limit harm wherever possible, taking into consideration all available alternatives, and the balance of different benefits and burdens that result.
Fairness: Persons ought to have equal access to health care resources, benefit ought to be offered preferentially to those who will derive the greatest benefit, and resources ought to be distributed such that the maximum benefits to the greatest number will be achieved.
Reciprocity: Certain patients and patient populations will be particularly burdened as a result of a reduction in non-essential services. As such, patients should have the ability to have their health monitored and re-evaluated as required.
Consider level of risk
The challenges of COVID-19 can differ for a number of reasons, including what is happening in your region/community, and within your patient population and focused practice area. As well, a second (and subsequent) wave could result in a resurgence of cases within your community.
Consider the level of risk and trends in your local area when deciding to see patients in-person. For example, what other businesses in the area are reopening, do you know the rates of your community transmission, how safe do people in your community feel?
The College of Physicians and Surgeons of Alberta suggest physicians answer a series of questions when deciding if a patient should be seen in-person or not:
- Is the patient visit important to the patient’s health?
- Does the patient feel the benefit of therapy exceeds the risk of leaving their home? In our collective efforts to flatten the curve and stay home, many of our freedoms have been curtailed, and our mindset has been altered. For our more vulnerable patients this is heightened. Keep this in mind as you discuss with them what they want and what they feel is an acceptable risk.
- Is the medical benefit to the individual patient worth the risk to you and your office staff/colleagues by having them travel to your office?
- Could further delay in provision of the care or preventative health maintenance result in a worse outcome for the patient?
- Will the care provided prevent the need for a patient to access acute care in the foreseeable future?
- Would a group of peers support the decision of the care being important? Would colleagues perceive these actions as being self-serving, rather than putting the needs of patients, staff and society first? For example, if there was an outbreak related to your clinic, could you justify your decision-making?
- Can you mitigate patient risk and keep yourself and your staff safe?
- Do you have adequate PPE for you and your staff? Do staff have the appropriate resources and training to support their decision making with regards to PPE preservation?
- Can you put appropriate measures in-place to optimize patient protection, including physical distancing, rigorous cleaning and disinfecting of common areas and high-touch surfaces, and limiting patients and patient flow (details in the appendix).
- Do you have a sick leave policy? It is no-longer acceptable for physicians and staff to come in to work if they are ill.
- In-Person or Virtual Care Visits? BC Family Doctors has created some excellent resources to help decide.
- How do you balance the benefits and risks of providing in-person or virtual care for patients? Beyond Essential Services in Primary Care provides a framework to assist with this question, based on the work of Dr. Tara Kiran and the BC Health Quality Matrix.