The AMA has published a checklist to manage the safe reopening of practices to best protect patients, administrative staff, clinical staff and the general public, at large. The AMA checklist builds upon guidance offered by the Center for Disease Control and Prevention (CDC).
Steps to be taken before reopening practices:
1. Comply with local governmental guidance in reopening and base the decision upon science, evidence and data.
2. Do not get ahead of what is allowed by the local administration and local governance. The dates of reopening and what can be performed vary state by state and county by county.
3. Make a detailed plan prior to reopening. Order enough medical supplies and Personal Protective Equipment. Develop plans and procedures to follow when any of the staff meet COVID 19 patients and if so, how long the staff have to be quarantined.
4. Create a plan for staff testing for COVID 19, including daily temperature checks and periodic COVID 19 tests with local labs. This is for the safety of the staff and the safety of your patients. Make sure to have all the staff members always wear a mask for the safety of the patients and other staff members.
5. Open incrementally with a soft opening and decide on services that can be provided in week one, two, three and beyond.
6. Telehealth is an important component and belongs in the new normal. Telehealth will be part of any practice moving forward. Plan and implement a tele-triage program. Discussing a patient condition and symptoms in advance can help direct them along the right path.
7. Ensure Workplace Safety so that the patients and all the staff are protected by reducing the number of patients inside of the practice at any one time. Rearrange the workplace so that the patients and staff can maintain the social and physical distancing required during this crisis. Also limit patients’ companions to a minimum or nil. Require all patients coming in to be wearing a mask.
8. Identify and coordinate with local labs and hospitals to send the patients for COVID 19 testing purposes. While selecting such places, ensure testing capacity and rapid turnaround times.
9. Limit or eliminate non-patient visitors for their safety, as well as for the safety of patients and all staff members.
10. Inquire of your medical liability insurance carriers so that you are aware of the rules and regulations related to the pandemic and what is and is not covered by your insurance.
11. Reestablish HIPAA guidelines and data security protocols. Employee test screening reports should be maintained confidentially. If a patient or staff member tests positive for COVID 19, that information should be maintained confidentially and should not be shared with other patients or staff members.
12. Consider all legal implications and if necessary, discuss with your attorneys.
Develop a policy for employees who may not want to participate in the reopening.
Understand the minimum reporting requirements in local community/health organizations for COVID 19 positive patients.
Identify which hospitals have the capacity to accept new COVID 19 patients.
13. Please do not assume that your supply chain will behave normally because it will not. Expect delays in each part of the supply chain. Every company and organization is reopening, as well.
The AMA has developed a template for pre-appointment patient screening questions. The answers to these questions must be shared with a decision-making clinician if the patient has answered ‘yes’ to any of the questions below to make sure that patient can be given an appointment. This set of questions, as published by the AMA, is given below:
1. Have you or anyone else in your household had any of the following symptoms in the last 21 days?
i. Sore throat
iv. Body aches for unknown reasons
v. Shortness of breath for unknown reasons
vi. Loss of smell
vii. Loss of taste
viii. Fever at or greater than 100 degrees Fahrenheit
2. Have you or anyone else in the household tested positive for COVID 19?
3. Have you or anyone else in your household received treatment in a hospital, nursing home, longtime care facility or other healthcare facilities in the last 30 days?
4. Have you or anyone else in the household traveled within the US in the last 21 days?
5. Have you or anyone else traveled on a cruise ship in the last 21 days?
6. Are you or anyone else in the household a frontline worker, healthcare provider or emergency responder?
7. Have you or anyone else helped or assisted in caring for a person in quarantine or a presumptive positive or has tested positive for COVID 19?
8. Do you have any reason to believe that you or anyone in the household may have been exposed to or tested positive for COVID 19?
9. To the best of your knowledge have you been near anyone who has tested positive for COVID 19?
Ref: Andis Robeznieks, Senior News Writer, AMA.
Ref: AMA American Medical Association
May 31, 2020