Criteria for exclusion from clinical contact w/ patients who have COVID-type symptoms

We continue to see sick patients with COVID-compatible symptoms @ our office though not all our providers/staff rotate through these sessions due to risk factors. Does anyone have a clear set of guidelines on exclusionary criteria for providers and clinical staff? Age cut-off? Certain diagnoses? Any guidance would be helpful!

Excellent question and I would like to hear guidance as well. Our office has run by self selection and declaration so far for working in the respiratory ill office. Not exactly ideal since we have higher risk providers and staff seeing ill patients and some lower risk not wanting to see ill patients. Has been tolerable with lower volume ill patients, but going to be tricky as respiratory season approaches.

Basically we fall back on universal precautions and the importance of PPE. Everyone should be low risk if following correct guidelines and PPE use. In ill office we are fully gowned, gloved, masked, and face shielded. In well office only mask and eye protection (goggles checking in and face mask if shots given).

The wild card is asymptomatic or minimally symptomatic patients at well office. We have had well patients that turn out to have COVID. This is causing a rethinking as we head into winter and larger ill visit volume. If provider/staff is higher risk then they have the ability to use the most extensive PPE at either well or ill office. We will continue to try and protect and limit exposure for higher risk providers/staff but there is also an understanding that they may need to step into uncomfortable situations and the proper PPE is available for use.

So hard to say who is higher risk and who is lower risk. It is like answering the question what is the difference between COVID symptoms and every other virus out there.

Also sounds like potential legal nightmare as an employer deciding who should and should not see ill patients if worst case scenario and one of us gets COVID and has bad outcome.

So basically great question and wish I knew the answer and we have been thinking about it as well and have hard time coming up with a solution. For us the key is having appropriate PPE to see the patients, protecting who and when we can, and understanding we work in pediatrics and will be exposed to COVID patients as part of the new job description in ill and well offices.

Imagine there are HR staff and lawyers struggling over same question. We should ask the teachers and school admin. Thus every 2hrs the plan changes.

Again I will say that latest 2hr thought in our office is that all providers/staff should expect to see COVID patients at some point, and that is a decision you have to be comfortable with and there is PPE to be used.

Thanks, Bill. It’s just comforting to know that we are not the only practice struggling with this. We are thinking along the same lines too and are beginning to have these conversations w/ some of our staff. Good luck to you!