Happy Holidays! As we move into winter and the COVID-19 numbers continue to rise and before I try to re-invent the wheel again, I thought I would reach out to see what you all are doing with your sick patients?
Right now, we have one doctor each afternoon to see anyone who screens positive. We rotate this provider each day. This allows for afternoon well visits and consults for the non-sick providers. Some days we have only a handful of patients, some days we have too many and this seems to be unpredictable (no pattern). How are you managing your templates to leave enough available sick time but not too much in case it does not get booked? Overall, our sick visit volume is way below normal.
Also, how are you managing your COVID-19 tests? Are you testing in your office? Are you testing only symptomatic patients and referring contacts to a stop the spread site? We are currently swabbing symptomatic patients and sending the tests out but some of the providers are interested in swabbing asymptomatic kids too and I am not sure I see the benefit. I’d love to hear your thoughts.
Sick appointments are down across both of our providers. We perform covid 19 testing (send out) in our office for both symptomatic and asymptomatic patients. This office visit is an appointment with a provider (not a nurse visit/nurse) as we would do for complaints of ear pain, sore throat, uri, etc. as this is not a swab-and-go situation. There is an inordinate amount work, health education, fu lab and results/reporting, providing work/school/childcare notes, printing and provided hard copies of COVID test results (parents need this documentation for work/childcare) including patient fu for those patients with sx but are managed at home. We schedule these appts/office visits in 15 minute blocks to afford us some extra time between appointments.
Hello Tracy,
We are all struggling with those same questions, I am sure evey office has slightly different set ups and man power. I have a solo practice, and I decided to keep most sick children out of the office and service them via telehealth only. Most families seem to be most reassured when I tell them that they can safely come to the office for their healthy check ups and vaccines with no exposure to sick patients. It has definitely helped me keep my patients up to date with their vaccines. I also changed my schedule template to every 20 minutes to allow extra time to clean exam rooms and do the extra work. I often do not see a need to test all children unless daycare or the parent’s work is requesting it. The negative antigen tests do not seem very reassuring to me, since they can turn positive later and give a false sense of security to patients. The PCR takes time for results to come back, sometimes too late to make any difference in management. Typically I have them assume they could have it, even if symptom free, and observe the quarantine recommended for their entire household. Symptomatic care can be discussed over telehealth. Doximity is a good option for telehealth and it is free. I feel it is really important to protect providers and staff as much as we can so we can keep working. Hope this helps you!
We are all in this together, keep safe and healthy!
I just started doing testing for sick and known exposed patients only. They take a lot of extra time we give them 20 minutes and then extra time for cleaning.
Hi,
We are doing all sick of almost everything (except injury/concussions) by tele. If they need to be seen we are doing afternoon outdoor (we also have a tent + heater) with us in full PPE. One staff start “sick outdoors” they are using separate computer , stethescopes/otoscopes/ and testing (flu/pcr COVID Abbot , strep etc) in full PPE , with changing gowns and cleaning between each pt. We have had some new Mom’s be +, so we see those babies over tele then bring them in for outdoor visit with us in full PPE. We have a CAR Covid template that bills for PPE. Parents are paying that as they are so appreciative of the safety and can see the time it takes for staff basically doing 2 visits.
We do have pcr for COVID that we use for truly ill kids in first 7 days and we laso have swabs from local lab we can collect for quarantine testing (Day 4-7 after exposure) or for kids who a same day + will not change what famiyl is doing.
In the in office WCC we have started taking WCC history “physically distanced” over tablet, then we go in to do physical; so we are not in the room > 15 minutes during WCC. This helps our staff spend < 15 minutes and protects families as well should staff become +.
We are also doing tele-WCC for 5 years and above for those payers who will cover (in CO that is BCBS< United, Cigna, and just recently Medicaid). If families are too fearful to come in we let above 2 y old use this sytem as well.
May you all stay well!
Cecile Fraley MD, CEO
Pediatric Partners SW, Durango CO
I am doing a hybrid of all of the above . I do not rotate personnel in a daily basis , I do it weekly to minimize exposure of all the physicians at the same time . We also encounter easier for a team to have the same duties several days in a row .
Several companies, schools and daycares have different requirements of participation or return to work . I had to test sports team players totally asymptomatic in order to participate in tournaments . This was a requirement from the school . Some daycares request siblings of possible/confirmed cases to be tested regardless of symptoms .
My waiting area is still closed and we pass patients directly to their examining rooms . We are seen sick in the office and some by telemedicine . With low number of patients and good infectious control precautions , I consider is low risk to see patients in the office . If one day our numbers goes up , we extend hours , and decrease the minutes of the face to face encounter , finishing the appointment over the phone . Now , the one change that has helped us tremendously is to have a second physician just on telemedicine in the evenings. They can work remote from home , but they have favor for now to be at the office .
We address issues on a weekly basis , incorporating new ideas .
My biggest challenge has been all the adolescents with depression , anxiety , insomnia and weight gain . The mental health services are saturated.
Since my last post, our community has experienced an uptick of COVID 19 (+/detected) results. Our patients are still being seen/tested in the office but we now have all patient’s tested give consent for a fu appt via telemedicine for when results are available. Instead of just telling the nurse to report (+/detected) results (and be bombarded with a ton of questions while on the call), the telemedicine appointment provides better healthcare, instructions and documentation. It also provides opportunities for a billable service (unless you have enough volume:(), an opportunity to address patients current symptoms, asthma or other chronic illness (and medication needs), missing chronic fu visits, vaccines, well checks, siblings in the home and potentially sick parents (care instructions, availability of Monoclonal antibody infusions), etc. We are constantly reminded at our now monthly PMI webinars (ending next week) that we have to come up with strategies to stay afloat besides recalling well check appointments. The sick visits we are accustomed to having are-no-where-to be-seen. Just a thought…
I have been doing all the counseling during the evaluation prior to the test. I tell them what to do if the test were to return negative and what to do if it were to be positive.
I also provide the information in writing and address how the symptoms should be managed differently if they have underlying conditions. I believe it’s the responsible way to handle it while awaiting results.