Planning for sick back in office?

Does anyone have a good work flow that they are willing to share regarding getting through a few hours of seeing SICK patients while wearing appropriate PPE?

I am thinking forward to the fall 2020 for viral & respiratory issues and wondering about changing rooms over between patients and charting in the computer?
And this is for hopefully non-COVID patients, but we have to treat them all as potentials.

Do you plan to wear full PPE (minus changing gloves and hand washing) the whole time?
What about charting?
Will you plan to do most of the visit by telemedicine first, then see the patient for an expedited physical exam - only if "needed’?
Thank your any ideas/suggestions.

We are obtaining a history by telemedicine or phone early in the day. When they arrive at the office, they call us, and we go see them in the car. I have a separate basket I take with me that has: thermometer, manual BP, otoscope, ear speculums, stethoscope, gloves, hand sanitizer, Covid swab and strep swab. I gown up and go see the patient. When I get back, I trash my gown (we are using exam gowns b/c I can’t find regular gowns) and sanitize my basket. Takes some time, but if I’m in a rush, I have my nurses do it. It’s not perfect by any means. Each sick visit adds an extra 10 minutes to my visit.

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Thank you Hiral.
We have done some visits like that too but I am thinking beyond that for when the weather turns inclement and the fall/winter season.
We want to continue screening for COVID-19 / CC / HPI / ROS by telemedicine or phone first, then bring them into the office, only if needed.
Just sorting through having sick patients eventually in the office and how to navigate MAs and providers in “more” PPE, charting, room cleaning, re-using gowns or masks (hanging on a hook?) and where to don & doff?
Yes, it will all add more time!

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I use a scribe (now working remotely) to make the time I spend with PPE more efficient. I bring my phone in the room so my scribe can listen to the visit. As I am donning and doffing my PPE and washing my hands I tell her my physical exam and plan for the last visit and she preps me for the next visit by going over the next patient’s problem list, last visit and med list.


We are also grappling with this question at our office in Tucson, AZ.

We currently see all patients with cough and/or fever in the parking lot. We obtain the history on the phone beforehand. It is becoming more difficult with our summer heat. We are trying to strike a balance that allows for a better workflow with the risk of exposure to our staff and doctors.

We are thinking of using an outside structure (think tent/awning tuff shed w/ windows) in the parking area for seeing sick (after telemedicine HPI/ROS).
Just a protected space against the elements for brief look in ears, lung exam, throat swab to be run in office, etc.
Considering logistics for:
Adding a hand washing station?
Maybe heater…?
Does anyone know if we need any kind of permit?
Such a crazy time!
Thank you in advance.

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We are seeing all sick visits as telemed first, in the early afternoon. For those kids that need to be seen in person, we convert the visit to an in person later in the afternoon (so telemed serves as history and some PE). We do curbside check in and bring them in the back door. We use a handful of rooms near the back door as our “sick rooms” so the kids don’t travel through the office. Depending on the symptoms and our clinical suspicion, we may only mask or may be in full PPE as providers. If I only need to swab and not do any exam, a provider does a parking lot swab. If I need to see and ear,etc, I can pop into the room and only do a limited exam based on what I learned in telemed. I have already discussed a possible plan with the parents and let them know that in order to minimize our contact time with potential COVID patients we will just do the necessary exam and then send them back out through the same door they came in.
This allows our providers to spend much less time in the room. If we are swabbing for anything we wear full PPE. Only my providers are swabbing currently. If we get to busy flu season and can’t do that efficiently, I will designate 1 MA to do swabs and any other interaction needed with full PPE for sick patients.
This is working well for us so far.

Our office did not shut down during the pandemic. Since school closed in mid march, we have not had many sick appointments. In preparation, we have designated a sick room for patients who have a history of fever (for whatever reason) or those who arrive for a scheduled visit and are noted to have a temp elevation on arrival to the office during the mandatory temp checks. We have clustered all “well” and follow-up visits in the morning hours only, leaving the remainder of the afternoon for “sick” visits/calls. We see the majority of our patient visits in the office. Occasional ADHD fu visit via telemedicine. We are a rural community with COVID 19 cases and deaths, but not like the larger cities for which we are grateful. COVID 19 testing is done in the same “fever” exam room with full regalia of PPE, gown, gloves, goggles and shield, etc., regardless of which staff member is performing the procedure. Otherwise, the check in staff in the business office wears surgical mask with “fashionable” cloth mask or cloth mask with filter. N95 if concern for COVID exposure, unexplained fever as they are the first point of contact (we have a glass barrier). The remainder of the clinical staff remains in surgical/cloth/filter/N95 through the patient care hours. Of note, we have had a mask/face covering mandate since April 18th (Maryland) and our families and children are compliant. Happy to be in the office for the time that we can and our families are grateful for adult contact and a “field trip” to sustain mental health! Be well. Be safe!

Thank you.
We are doing similar as well:
Well visits in the morning.
All sick visits start with a telemedicine visit.
Car visits are good but not optimal due to car seats, other siblings in the car/van (masks on and off), bad weather. Tough on some staff members lower backs as well to lean into a car. Some families cars have either no A/C or heat.
Unfortunately, we do not have windows that open in our office to increase air exchange.
And we are assuming everyone is potentially POS COVID-19 or an asymptomatic carrier, so wearing appropriate PPE at all times.
So, what about RSV infants, coughing children, kids who need throat swabs, kids sick with flu, etc.?
I guess my biggest concern is still sick children who need to be seen…and the risk of bringing them into the office (designated sick room and sick hours) and possibly needing to SHUT a room DOWN for at least ONE hour.
Trying to be hopeful that it won’t be too bad when kids go back to school but really many unknowns still ahead.

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Have you looked at HEPA air purifiers? We are on the 3rd floor so can’t open windows. We bought air purifiers for every room and waiting room.

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Hi. We have just started swabbing patients in the car and keep fine tuning our process. Our MA’s state they have a hard time swabbing patients in the car. Any tips I can offer them? What is your cleaning routine for your sick exam rooms? We are running low on cavi-wipes. The contact time differs depending on what cleaner is used. Some have us wait 1 hr which we cannot do as we only have 6 exam rooms for 3 providers. Thanks!