What happens to your practice when COVID-19 walks through the door?
That's no longer a rhetorical question for Houston's Village Medical. The 100-physician family practice has had two unexpected COVID-19 patients since Feb. 26. As a result, the practice lost three physicians and one nurse to mandatory, 14-day home quarantines, according to Clive Fields, MD, chief medical officer and co-founder of Village Medical.
"The concern is, at this rate will there be doctors left to give care to patients?" he told Texas Medicine Today.
These and other shocks to the system have prompted Village Medical to modify how it cares for patients, especially those who show COVID-19 symptoms.
"It's not something you should wait around for – there are steps that can be done to prepare," he said. And Dr. Fields says he hopes many other practices can benefit from his group’s experience.
Some of the lessons Village Medical has learned include designating at least one physician to stay on top of medical developments and best practices related to the illness.
Important developments should be communicated to the rest of the staff. That can include following guidelines from the Centers for Disease Control and Prevention and the National Institutes of Health, Dr. Fields says.
That information is helpful, "but for many of us it's so overwhelming, it's hard to decide what applies to you," Dr. Fields said. For instance, his practice struggled to get definitions from health authorities for "brief" or "prolonged" contact with COVID-19 patients. Physicians with brief exposure did not need to be quarantined, while those with prolonged exposure did. Local health authorities defined "prolonged" as two minutes or longer, meaning the physicians in question had to be quarantined.
Practices also should post and frequently update information on COVID-19 for patients, especially practical information like ways to self-screen. "We've spent a huge amount of time posting information to our website that patients can be referred to, and continually updating frequently asked questions," Dr. Fields said. "Because regardless of every situation you can think of, another one will show up today."
In addition, practices should set up procedures to triage and treat patients who may have COVID-19. Most practices will need to alter how they deal with patients at three points of contact: the appointments center, the front desk, and exam rooms.
- Appointments center: Educate operators to not automatically schedule possible COVID-19 patients to come into the office. Patients who have symptoms should be directed to the local health authority (if possible), which will direct them to an appropriate emergency facility. "But the goal should be, for a COVID-19 patient under investigation who is not currently experiencing life-threatening symptoms, to be directed to stay at home, be reassured, and be monitored by telehealth and telephonic communication," Dr. Fields said. "There is nothing that can be provided to those low-risk patients that cannot be provided at home."
- Front desk: Make sure the front desk knows how to screen for patients with COVID-19 symptoms. If a patient screens positive, direct him or her to a predetermined room away from other patients and staff.
- Exam room: Make sure physicians, nurses, and other staff have personal protective equipment on hand to so that they can safely examine the patient without being exposed to the disease. (See the “Infection Control and Personal Protective Equipment (PPE)” section of TMA’s COVID-19 Resource Center for details.)
Other steps practices should take to protect staff and patients from COVID-19 exposure include:
- Ramp up telemedical services: Telemedicine is needed to safely direct potential COVID-19 patients to the correct level of care. In fact, it is the CDC's preferred method of evaluating patients for COVID-19 infection. (Want to learn more? See TMA’s “Considering Telemedicine in the Wake of COVID-19?”)
- Proactively contact at-risk patients: Use electronic health records to identify the patients most likely to be in danger from COVID-19 to check up on them by phone and to let them know what to do if symptoms do appear, Dr. Fields said. Also, confirm that they have all medications and other supplies needed to be quarantined for 14 days.
- Prepare to consolidate: If your practice has multiple offices, you may have to consolidate locations temporarily as physicians are either quarantined or come down sick.
- Expect an increase in call volume: Village Medical's call volume jumped 20% over pre-COVID-19 levels, Dr. Fields says.
Stay up to date with the latest news, resources, and government guidance on the coronavirus outbreak by visiting TMA’s COVID-19 Resource Center regularly.
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