Separation of Well and Sick Patients

I manage a large pediatric practice in southern Indiana. We have had the luxury of physically separating sick from well patients since when Covid started. Thankfully our recent increase in volume is making the physical separation difficult at best. Is anyone else out there “mainstreaming” their sick patients back into the practice since providers and staff are vaccinated? To note, we will still separate patients in the waiting room - having sick patients wait in their car.

We ARE still separating our well and sick however the “sick” are screened prior to scheduling. If they are fever free, no Covid contacts, and have issues such as derm, ADHD, UTI, injuries, etc. these sick are worked into the well scheduling blocks. The truly sick- those with fever, Covid exposure, sore throat, headache, cold-like symptoms, etc. are scheduled in the sick block. We only allow one family at a time in the waiting room to avoid the exposure to others.

We are a 7 provider practice 20 miles outside of Boston and we are still following our rules from last July which is seeing well visits and non-ill sick visits in the office and seeing anyone who is ill with fever, cough, vomiting, diarrhea or any COVID-19 symptom in the car in our parking lot. The parking lot visits start with a telehealth visit with the family on their phone in the car and then finish with us gearing up into PPE and going out to the car to do any exam needed and any swabs needed.

We have not reopened our waiting room so everyone that has an in-office visit is still waiting in their car until their room is open. We call them in their car when it is cleaned and ready and then they walk into the office right to their exam room.

I think most families like to wait in the car instead of the waiting room and many have expressed the desire in the future to not use the waiting room even if we reopen it. We are lucky because as our parking lot is close to our front door, the distance from any car to exam room is no longer than a walk of 90 seconds.

About 4 months ago we started to ask parents to stop at the front desk to make a next appointment so those are the only people in our waiting room. I do not know how we will utilize our waiting room in the future.

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We are having a conundrum here. We have a very large waiting room (separate newborn waiting areas) and have removed half of our chairs to provide social distancing and also have designated sick and well waiting, but have not allowed sick patients to wait in the building yet. We have been sending sick patients back to their car after checking in. On rainy days, hot days, for patients who walk to their appts, or those families with multiple children, sending them back outside to wait is a point of frustration. Most are called to re-enter within 5 minutes from being sent out, so it’s unload all over again.

Of note… we went down the whole contactless check-in route with 2 different solutions, but neither were a great success. Parents without minutes on their phones to go through the check-in process. Grandparents or others bringing the child to their appt and not having the phone number we used to identify the patient, so we’d have to call parent to call whomever was with the child… could not get updated billing information through this method. So then we went to drive up/thru check-in, but that requires a full time, designated person at the station without a phone, scanner, money drawer, card reader, etc. All in all, we resorted to installing protective glass barriers at the desk and having patients walk-in to check in.

With the complete separation of sick and well areas and socially distanced seating, how do the members of this forum feel about re-introducing sick patients back into the waiting areas?

We setup virtual check-in with a text link to check in or through the patient portal app (eClinicalWorks). Some glitches, mostly with communication issues with eCW. It is working pretty well at this point. We only have wells come in through front door and sick patients are met at the back door by the nurse after the nurse calls them and gets their HPI. Our patient population does not have an issue with having cell phone service, so we don’t have that issue. We don’t anticipate going back to the way it was for a long time. Even to the point of discussing what we can do with the extra space created by not using all of the waiting room. Covid or flu vaccine clinics??

Hi, I run a small pediatric practice in long beach California. The state is “going back to normal” on June 15th. Those who are vaccinated are no longer recommended to wear masks. California is relying on the honor system that unvaccinated patients will still wear masks. We have been screening patients prior to each appointment via text, stage patients in the parking lot, allow only one patient/family in at a time, and separate sick from well on the schedule. will anything change for us after the 15th?

I’m considering asking the patients as part of the screening process if they prefer wearing masks during the visit.

I’m also considering no longer staging patients in the parking lot as it has limited our throughput significantly. the risk is that there will be screening symptom-free (possibly masks-free) patients mingling in the lobby.

Hello, We are also a small practice in Wyoming. We are continuing to use virtual check in and not allowing anyone in our waiting room. We will continue to wear masks in our office and ask all parents to do the same. We do allow sick patients in the office, based on symptoms and any fever is done via telemedicine. We continue to offer COVID testing via our parking lot and our patients really seem to like the process.