It is critical that COVID-19 infection in the care environment be contained to restrict the infection from spreading to patients and staff. A critical first step is to restrict the traffic in and out of the hospital and eliminate areas where patients and staff congregate. A key set of tools to achieve this is telemedicine which allows patients to be seen remotely both outside and within the healthcare facilities[9]. A pandemic will also require facilities to create patient barriers, infection areas, wards, floors and even buildings to help contain infection spread.
Ideas:
- Close down/empty or reduce density in the waiting room.[10]
- Facilitate scheduling, registration, check-in, insurance verification, coding, billing and appointment reminders through portals, on-line registration APPs, patient experience/engagement APPs. Most on-demand telemedicine platforms enable this.
- Create a virtual waiting room that is convenient to the patient. For example, have the patient schedule and register for an appointment online, then have the patient announce their arrival for the appointment by text, then wait in their car until they are called or texted to come in. Provide hand sanitizer outside the door and upon entering the building/office, the patient is then routed directly to their provider, lab tech, etc. On-demand telemedicine and queueing software applications are available for this.
- Three telemedicine technologies that can enhance this process are AI-powered chatbots, portals and kiosks.
- AI telemedicine chatbot can enrich the registration process. The structured interview helps both patient and provider collect and sort relevant data before the patient sets foot in a doctor’s office. A chat bot can also provide context specific response, instructions and directions to the patient.
- Portals allow the patient to schedule an appointment, register, and be given added value response, instructions and directions prior to entering the facility. It has also been shown that patients give more complete and accurate information to a portal (or kiosk) than they give in person to a registrar. This can save time and money in the registration and billing processes.
- Physical Check-in kiosks present risks in a pandemic situation as they are used by multiple patients creating a transmission site for the virus. Virtual check-in eliminates this. However, certain kiosks are available to take images and temperature without contact.
- Provide for free testing and infection surveillance of hospital workers.[11]
- Allow and enable staff to work from home (tele-commute) whenever possible reducing their exposure and the risk of carrying infection into the hospital. This will also allow staff that have been exposed to COVID-19 or are infected, but not seriously ill, to continue to fill at least a portion of their operational role.
- Assure connectivity to the home especially in rural areas.
- Conduct a connectivity survey of all employees who can potentially work from home. Know the connectivity capabilities and gaps in advance. Update every year.
- Automated disinfection is being employed by airlines, factories and hospitals. Some hospitals have adopted portable enhanced environmental disinfection systems (robots) that feature ultraviolet-C (UV-C) light or hydrogen peroxide vapor (HPV) to complement infection control protocols already in place. These robotic technologies are widely available today.
- To control infection, it is advised to maximize air flow and filter/disinfect the air using UV and HEPA filters in ventilation[12]. Consider ventilation systems that move the air vertically rather than across patients and space.
- Plan ahead and create the capability of pandemic-only wards and/or floors to contain the infection. Assure restricted access and proper ventilation, not shared with the rest of the facility. Design containment entry/exit points with UV or other disinfection in the ventilation systems. Conversion of these spaces. This will take advance planning. However, repaid build containment structures designed to be in the hospital are also available.
- Have sufficient negative pressure rooms or rooms/floors that can be rapidly converted.
- For containment of a limited number of infected patients, containment cubicles and enclosure tents can be set up quickly for containment of patients. These structures protect staff and have their own Hepa filtered ventilation.
- Multiple healthcare systems converted current sites to pandemic-only facilities to care for infected patients. In some cases, these were unused hospital facilities. In other cases, hotels and even stadiums were converted for temporary use (alternate care sites). Use the CDC guidance for Alternate Care Sites.[13]
- To protect providers, reduce the need to enter infected rooms by providing a “Pad on a Pole” for each patient in the hospital. This local application of telemedicine technology allows patients to communicate with staff and family outside the room to the extent possible and allows providers to visit patients without entering the rooms (and significantly reduces demand for PPEs).
- Consider training staff to diagnose, triage and respond making use of telemedicine and mixed reality tech can reduce exposure and provide a lifelike training model (e.g. HoloLens or other AR glasses and simulation programs).