There are some simple steps that you can take to help schedule and manage in-person patient appointments. They include:
- Seeing just a handful of patients in the morning or afternoon only, with immunocompromised patients earlier in the day.
- Scheduling patients with respiratory symptoms (acute or chronic) during designated time slots—at the end of the day.
- Seeing patients one/two evenings a week or on some weekends – these can be more accessible to patients (and physicians) who otherwise would need childcare, etc.
- In multi-physician offices, one physician in the office sees patients in-person per day – prevents cross-infection (exceptions for urgent care).
- Splitting up the week into sections of half-day blocks on different days, shared across the practice. One care provider or one “team” of providers sees all patients with suspected or confirmed COVID-19 or refers to a centralized testing and assessment site, if available.
- Intersperse your virtual appointments with in-person appointments to avoid a build-up of patients in the waiting room and allowing time for staff to disinfect.
- Identify which services can be delivered via telehealth and continue to conduct those visits remotely.
- Administrative staff whose work can be done remotely should continue to work from home.
Before the appointment
- Begin all patient appointments by telephone or video, followed up with an in-person appointment if a hands-on assessment is needed:
- When determining if an in-person visit is necessary, balance the patient needs (e.g. encounter type, acuity/severity of complaint) and risk factors (e.g. patient’s age, comorbidities) against the risks of exposure.
- During the telephone or video portion learn the history of the presenting illness so that your in-person visit is minimized.
- Review with patients the reopening logistics and protocols and screen patients for COVID-19 risk.
- Inform patients that non-essential accompanying visitors are discouraged where possible. Make exceptions for children or caregivers as you see fit.
- Advise patients and accompanying essential visitors to practice diligent hand hygiene, cough etiquette, and physical distancing.
- Patients should be screened before physically entering the practice. If possible there should be a dedicated room or space in the parking lot for this purpose. Persons accompanying the patient need to be screened as well.
During the appointment
- Conduct a Point of Care Risk Assessment. Currently, all five Health Authorities recommend a procedure/surgical mask, eye protection and gloves/hand hygiene for any in-person contact with patients in community.
- Maintain a 2 metre distance when interacting with patients and your colleagues, and wash your hands frequently. When you can’t, increase your level of PPE.
- Minimize the number of tasks that have to be done in the exam room, such as chart completion.
- For those seeing patients with symptoms suggestive of COVID-19, the addition of a Level 2 gown is required.
- For those seeing such patients, wear fit-tested N95 respirator when in room with suspected TB patients, patients with suspected/confirmed COVID-19 undergoing aerosol generating medical procedures, and patients who may be infected with emerging pathogens with suspected airborne transmission.
After the appointment
- Perform cleaning protocols (listed below) for the room, stethoscope, and any equipment used.
- Properly doff and dispose of PPE if leaving the patient care area (e.g. at end of shift or during a break) or when PPE is visibly soiled or damaged.
- Wash your hands.
- Conduct any necessary follow-up via telephone.
- Wherever possible, provide a separate entrance and waiting area for patients with symptoms suggestive of COVID-19.
- Minimize the number of patients in a waiting room at any given time. For example, ask patients to wait outside or in their car, and then call them in one at a time.
- If possible, designate one exam room for all patients with symptoms suggestive of COVID-19, as close to the entrance as possible to minimize patient travel.
The following tool may help community physicians identify resources available to help them. The example provided is from the Victoria and South Island Divisions of Family Practice and will need to be modified for services available in each community.