The COVID-19 Pandemic: A letter to our community physicians and providers
March 25, 2020
Dear fellow pediatric healthcare providers,
As I write this today, community spread of COVID-19 has begun in our region. This reality requires each provider and practice to fully commit to best practices on an individual and system level in order to protect our patients, families, employees and our greater community. Our CPAC group, working with the CCHMC COVID-19 leadership response team and Physician Outreach, is making every effort to ensure we are sharing best practices with you as soon as possible through the daily email from Therese Martin and updates on the Cincinnati Children’s external site : https://cincinnatichildrens.foleon.com/microsite/coronavirus-covid-19/home/ If you, or someone in your group, are not receiving these emails from Therese because your hospital system blocks them, you can send physician outreach a personal email to use (PhysicianServices@cchmc.org) or check the website daily for the updates.
On a practice level, our decisions should be based first on safety. To that end, these are recommendations for your practices during this time:
1. TEAM Ensure you have a provider and management leadership team reviewing your state health department guidelines, state orders, and CCHMC COVID 19 information daily. Adjust practice protocols as needed.
2. WORK FROM HOME Enable essential employees without direct patient contact (phone nurses, billing, scheduling) to work from home as much as possible if you have not done this already.
3. LIMIT WELL VISITS Limit in person well visits to children requiring vaccines or have an urgent need as much as possible. Reach out to families to offer to be placed on a recall list or schedule for the summer.
4. LIMIT IN PERSON SICK VISITS Limit in person sick visits to those who need to be seen. Develop a clear list in your practice for what needs to be seen and share with your team. USE TELEHEALTH for ill visits you agree can agree can be managed this way such as med follow-ups, minor illness, mental health, quick check in instead of WCC, provider COVID screening visits.
5. SEPARATE ILL AND WELL VISITS Separate ill and well visits by location or time of day if you have not already done this.
6. SCREEN FOR COVID 19 EXPOSURES AND SYMPTOMS (FEVER, COUGH, SHORTNESS OF BREATH OR SORE THROAT) IN EMPLOYEES, PATIENTS, AND FAMILY MEMBERS CONSISTENTLY
Employees – Screen ALL employees and providers for sickness or fever on arrival. Send sick employees/providers home. Review CCHMC return to work guidelines based on CDC and adapt for your practice. Patients and families on pre-registration for WCC or on arrival- Preregister patients before arrival to minimize time in waiting room. During that call, screen for sickness in patient or family members. Reschedule the WCC and offer nurse triage if the patient/family members have respiratory symptoms or fever. Ensure screening complete again on arrival. Consider temperature screening on arrival for patient and caregiver. Limit visit to one other caregiver to accompany child. If it is an essential visit (i.e. newborn, etc.) with a symptomatic caregiver, place a mask on the caregiver and patient. Sick visits on initial phone call and on arrival - Triage well over the phone to determine best location for visit for those with respiratory issues (home, office, ED). For patients with mild possible COVID symptoms, review home care and when to call back. Providers and staff with close contact (10 min within 6 feet) of screen or symptom positive ill patients who arrive in your office should follow contact and droplet precautions (Mask with eye protection, gloves and gowns) for that visit.
7. REVIEW SCREENING AND PROPER PPE FOR ILL VISITS LIMIT PROCEDURES THAT MAY GENERATE AEROSOLS Ask asthma patients to bring their inhaler with them if having respiratory issues and need to be seen. Review the CCHMC COVID-19 site for guidance on aerosols in the office. https://cincinnatichildrens.foleon.com/microsite/coronavirus-covid-19/resources/
8. PROTECT Consider rotating voluntary time off for providers and staff to reduce exposure time and reduce operating expenses. Many practices have found helpful information about operations through the PMI/PCC webinar (second installment coming this week). (https://www.pediatricsupport.com/)
Please do not hesitate to send questions to the PhysicianServices@cchmc.org email. If we do not have the answers, we will work to get them for you. We will continue to update the website with information as it is available. Please stay safe and healthy and help your patients and employees do the same!
Sincerely,
Shelly F. Voet MD
CCHMC Executive Community Physician Leader