It is critical to protect staff, patients and the facility from infection exposure while still continuing operations and quality care delivery. The best way to do this is to divert potentially infected people before they arrive at the hospital or clinic. The CDC suggests that providers first evaluate patients with suspected cases of the virus remotely instead of having them come to the hospital. Some clinicians, hospitals, and healthcare insurers are telling patients with mild symptoms to conduct their initial doctors’ visits via phone, video, and secure messaging. Diverting potentially infected people can be accomplished in many ways.
Ideas:
For staff and facility workers:
- Conduct frequent testing.
- Screen on arrival outside the hospital – create pre-entry rooms (tents, trailers, secure areas in the entryway) if possible. Screen every person for temperature and pulse ox and other symptoms before they enter the facility.
- Use telemedicine during the process to address needs of infected ED arrivals while reducing need for interaction with staff (and reduce need for PPE).[8]
- Allow and enable staff to work from home whenever possible, reducing their exposure and the risk of spreading the virus infection in the hospital.
For patients:
- Close down (empty) the waiting room by creating virtual or drive up waiting rooms (see Critical Need #5).
- Encourage use of on-demand, direct-to-consumer telemedicine platforms to answer basic health questions and triage. If COVID-19 related, most of these telemedicine services are able to conduct the CDC COVID-19 screening online or remote (i.e., over video) as part of the consult registration process.
- COVID-19 (screen, test, triage, divert to appropriate place of care) – if a patient is diverted to the home, provide support, monitoring and communications to encourage healing and containment; intervene if the patient needs a higher level of care.
- Use phone or online tools so patients do not have to come in-person for care.
- Use existing COVID-19 screening tools to conduct virtual CDC screening.
- Apply AI such as using telemedicine chatbot tools for screening, decision support and triage. (An additional benefit is that chatbots have proven to generate a more structured and informed response than a human interaction and they require very little staff resource time reducing demand on staff and enhancing surge capacity. Dozens of these tools are in place and available.)
- If likely infected, direct to drive through or home testing.
- Use virtual tools such as chatbots to inform patients of test results and to answer questions.
- If infected, direct to physician (virtually), set up virtual telemedicine appointment and triage.
- Route to the best site of care. Tell the patient where to go next e.g., to home or a COVID-19 specific facility.
- Direct patients to the facility for emergencies or when an admission to the hospital is required or,
- Direct patients to their home or place of residence, where care in the home is appropriate.
- Engage and monitor patients at home using telemedicine. Provide iPads or other technology (whenever possible use the patient’s own technology) to allow care providers to monitor the patient and deliver continuity of care. Ensure that the technology also allows patients to engage with family and friends to reduce isolation and encourage healing.
- Provide regular daily contact to the patient at home to inform, answer questions, advise of critical behavior to reduce spread of disease. Use existing contact management tools (e.g. Salesforce Health or your telemedicine platform) to assure, structure and assure follow-up care.
- Implement/leverage existing engagement, Remote Patient Management (RPM) and data sharing tools. Implement evaluations and triage of patients based on data.
- Home monitoring of patients – implement basic RPM tools to provide a daily assessment, measurement of temperature and pulse ox (as well as measurements appropriate for any chronic disease). Provide daily contact with the patient and, where possible, the caregiver. Daily video contact is preferred but phone (audio) may be sufficient.
- Consider use of location monitoring to know if patients stray from home; phone location monitor Apps are available (if socially acceptable).
- Wearable location monitors are also available for problematic cases.
- Patient/public-facing messaging is critical to reinforce messages concerning the disease, care and recovery. It is also critical to provide continuous reinforcement of the need to quarantine, what quarantine means, the use of masks, social distancing and frequent hand washing. A major issue in COVID-19 is that patients, care givers, etc. are being fed a wide variety of often conflicting information through social media and word of mouth. Your public facing messaging must assume that it will have to counteract misinformation. (See Critical Need #11) Most RPM and CDM telemedicine platforms support this communication.