Eliminate waiting room magazines; cross-train staff for all essential functions; reorganize waiting area to “contain” febrile patients. Check, check, check?
The American Academy of Family Physicians (AAFP) has created a comprehensive checklist to help physicians and staff prepare office locations and daily operations to accomodate the COVID-19 pandemic. You may have thought of everything on the list, but maybe not. Click through our summary of the document which is based on the AAFP assumption that: Transmission will be primarily through exposure to respriatory droplets and direct contact with patients and their contaminated environments.
Universal Early Preparation: Vaccinate all staff and their families against seasonal influenza. (This will help differentiate seasonal influenza from the pandemic variant, help keep the health workforce healthy and may have some ameliorating effect on the pandemic variant.)
Practice Triage. Develop a triage protocol for your practice based on local patient and community outbreak. Recommend that patients with respiratory symptoms & fever call office before arrival. Distribute respiratory prevention packets to all symptomatic patients (disposable surgical mask, facial tissues, cleansing wipes).
Structural Changes.Consider arranging a separate entrance for symptomatic patients. Reorganize waiting areas to keep patients with respiratory symptoms a minimum of 6 feet away from others and/or have a separate waiting area for patients with respiratory illness. Schedule patients with ARI for end-of-day appointment or at another designated time.
Objects of Transmission. Discontinue the use of toys, magazines, and other shared items in waiting areas, as well as office items shared among patients, such as pens, clipboards, phones, etc. Dedicate equipment (ie, stethoscopes, thermometers) to be used in ARI areas; clean after each use with appropriate cleaning solutions
Consider use of disposable equipment (eg, blood pressure cuff) when possible.
Containment, Disinfection. Isolate all patients with suspected symptoms of any respiratory infection using doors, remote office areas, or negative-pressure rooms, if available; evaluate promptly. Leave exam room after appointment as quickly and directly as possible (ie, complete documentation in clean area). Clean room and all medical equipment completely with appropriate cleaning solutions.
Ubiquitous Necessities. In all reception, waiting, patient care, and restroom areas: Provide no-touch waste containers with disposable liners. Provide alcohol-based hand rub and masks. Provide boxes of disposable tissues for patients. Provide single-use towels and gloves throughout the office.
Patient Referral or Transfer. While a patient waits for diagnostic test results, home isolation may be required.
Develop patient education materials to inform these patients of the reason for home isolation and the process to be followed. Ensure transportation to a referral/transfer site is handled by a previously exposed family member in a personal vehicle, or by a health facility vehicle such as an ambulance.
Human Logistics. Prepare for office staff illness, absences, and/or quarantine. Plan for increased absenteeism rate.
Cross-train staff for all essential office and medical functions. Educate staff about alternative office management plans, where appropriate.
For additional information, AAFP recommends these Key Pandemic Influenz Web Sites
And, see the most recent update to the AAFP office preparedness checklist.