With Masks, Screening, Distancing and Lots of Cleaning, Offices More Than Ready for Patients
When COVID-19 hit the Philadelphia area, Einstein Healthcare Network outpatient practices got innovative.
They switched to telehealth (phone or video) for most visits, and they reached out to patients with chronic diseases by phone to check on them.
The offices couldn’t do routine well visits, such as shots for children. But they never stopped seeing patients. Now they are able to do almost all types of visits, with enhanced screening and cleaning procedures designed to promote social distancing and keep patients and staff safe.
New procedures include:
- Pre-screening patients by asking about symptoms by phone
- Converting visits to telehealth for those who may have COVID symptoms
- Requiring masks for all staff and patients
- Taking several steps to avoid or minimize time in waiting rooms
- For those who must wait, spacing out chairs to ensure social distancing
- Cleaning exam rooms after every patient and waiting rooms multiple times a day
“I want patients to know that we’re here for them, we’re open for business,” says Christopher Scaven, DO, a family medicine doctor and Medical Director of Einstein Community Health Associates, the organization of Einstein primary care doctors in Philadelphia.
“We’re concerned about their health and we want them to please reach out to us and schedule their office visits,” he says. “It’s our responsibility to let patients know that they can come back to the office safely and we’re not going to put them at risk.”
Vaccinations and Chronic Disease Care
Angie Nicholas, MD, a family physician and Chief Medical Officer at Einstein Medical Center Montgomery, says she’s especially concerned about children who are not getting routine vaccinations. “We’re really trying to reach out to get them in, to take care of those routine medical needs because babies missing their vaccines is a really significant issue right now.”
“For the adults who are not getting care,” Dr. Scaven says, “the biggest concern is that they’re not going to take care of themselves, not take their medications routinely.”
Doctors’ offices have been calling patients with diabetes and high blood pressure, for example, to make sure they have all of the medicines and supplies they need. Physicians also have called patients about doing home stool test kits for colon cancer screening, Dr. Nicholas says.
Steps like these have helped to provide care to patients who were afraid to come to doctors’ offices during the height of the COVID-19 pandemic in March and April. Although most visits were converted to telehealth, overall the number of appointments dropped significantly.
Wellness Visits Resume
For several weeks, providers also stopped seeing patients for some wellness visits, screening procedures such as colonoscopies, and pre-operative visits, since elective surgeries were canceled.
Now the Philadelphia offices are seeing children up to age 6 for wellness check-ups and shots, Dr. Scaven says. Night and weekend visits, and well-child visits for those up to age 21 will start again on July 1.
Adult wellness visits started on June 1, and offices also are seeing people who need pre-op visits. Einstein surgeons this month resumed performing elective surgery and diagnostic procedures such as colonoscopies to screen for colon cancer.
Einstein Physicians Montgomery never stopped well-child or well-adult visits for patients who needed them, Dr. Nicholas says. They occurred at times of the day when only well patients were seen, to make sure that well patients were not exposed to sick patients.
Screening All Patients
When patients call for an appointment now, they will find some new processes in place.
“We are screening every patient before they come into the office, making sure that we understand what their sickness is, if they’re coming in because they’re sick,” says Dr. Nicholas. “Before the patient actually comes into the office, we’re taking their temperature. Then we are requiring that every patient walk in with a mask.”
People who have symptoms that might be caused by COVID-19 are scheduled for a telehealth visit or, if symptoms are severe, sent to the emergency room. Those who don’t have such symptoms in most cases can have a choice of seeing a doctor in person or by telehealth.
On the day before a visit, Dr. Scaven says, a staff member calls to confirm the appointment and to ask questions again to check for COVID symptoms.
Social Distancing and Sanitizing
People who are driving to the visit are asked for a cell phone number, and a staff member calls them 15 minutes ahead of time to check on insurance information, he says. Then they stay in the car until it’s time for the visit, when a staff member wearing a mask walks them straight back to the exam room.
Walk-ups are also taken straight back to the room after speaking with someone at the front desk.
Those who do have to wait will find that chairs are spaced out to maintain social distance.
“We’re making sure that we are sanitizing every room after we see patients, wiping down all of the surfaces between every single patient,” Dr. Nicholas says. “We’re also cleaning the waiting rooms two or three times a day, wiping down every surface.”
Stethoscopes also are cleaned with alcohol wipes between patients. Even computer keyboards and phones get sanitized multiple times a day.
“If a patient is sick,” Dr. Nicholas says, “then we’re wearing appropriate personal protective equipment.”
Telehealth for the Long Term
Dr. Nicholas and Dr. Scaven are looking forward to seeing more patients who need care, but they also think that telehealth is here to stay.
Doctors started using telehealth more during the height of the COVID pandemic to help keep patients and staff safe. But they also were able to get paid for phone calls for the first time as Medicare, Medicaid and commercial insurance carriers changed their rules. Payers also expanded coverage for video visits.
“We’ve adapted pretty quickly to telehealth,” Dr. Nicholas says, noting that it has several advantages. For example, if patients have concerns on the weekend, the doctor can see them on video – perhaps to look at a new rash – instead of just talking on the phone.
“We’re also able to add people to the visit, like visiting nurses or maybe multiple family members because we don’t care for just the patient. This is an opportunity for us to engage the family as well.”
Patients also seem to like telehealth, Dr. Scaven says. “I think they like the idea that we can still provide care for them in the safety of their own home.”
“As unfortunate as this pandemic has been, it’s changed the way we practice medicine,” Dr. Scaven says. “To me this is a great opportunity to take advantage of the telehealth platform that was already out there.”