As you prepare to resume outpatient services, there are several considerations and opportunities to improve the safety of your staff and patients. Array has developed a consolidated toolkit to reduce infection risk, acknowledge and ameliorate patient and staff anxiety, and streamline patient throughput. We have also included links to expanded resources and sample products to support your teams.
Here's what we know: consumers are fearful. We expect that routine screenings, annual physicals, chronic disease management, and consultations for minor illnesses will be postponed due to uncertainty. Pre-visit communication is an opportunity to communicate safety precautions and provide vital guidance about the inherent risks of delaying care. Separate suspected and symptomatic patients by location, hours, or discrete zones with an alternate access point.
Develop and implement standard e-mail and text message instruction reminders including testing requirements prior to visit, PPE expectations during visit, screening protocols upon arrival, guidance for support / family members accompanying the patient, and reinforcing your infection prevention measures and processes.
Develop standard algorithms for determining which visits are appropriate to conduct via telehealth even after reopening the clinic. Determine which patients can be assessed by scheduling / clerical staff and which require review by a clinical team member to schedule for a telehealth visit.
Develop standard protocols for assessing patient symptoms during reminder calls. Implement algorithms for determining which symptomatic patients are candidates for telehealth. Consider rescheduling non-urgent appointments for symptomatic patients.
Recognize staff may be experiencing increased stress levels; communication and engagement may improve staff satisfaction. Consider starting and ending each shift with cross-functional team huddles. Start day with 'Safety Moment' and mindfulness exercise, close each shift with a Continuous Improvement plus/delta huddle. Create a policy for pre-shift temperature/wellness checks. Communicate expectations around scrubs vs street clothes/changing on-site, directional access, and personal devices.
Space scheduled appointments further apart to allow for immediate rooming after checking in to reduce the number of people in the waiting room, allow providers more time to assess the physical and emotional needs of their patients, and allow for more rigorous cleaning of exam rooms between visits.
If patients will be traveling by car, consider instructing patients to await a text prompt prior to entering the practice site.
Consider how staff may need / want to change when arriving in the morning or before leaving to go home. Consider re-purposing some spaces for lockers/changing to accommodate staff that previously did not typically change before/after their shift. If patients suspected of COVID-19 will be seen in the clinic develop PPE protocols for those encounters and appropriate space to don and doff.
Define your screening protocol and adapt physical settings to support it. Consider contact-less temperature scans, oxygen saturation, as well as remote camera monitoring and screening interviews from a central call center to multiple entrances and/or facilities using IP cameras. Consider remote access control door release to prevent entering without screening at entrances without assigned staff.
Assign a staff member to act as a roving greeter to screen arriving patients, provide guidance for PPE, direct the check-in process and where to sit, and next steps. Consider having the greeter be responsible for the sanitizing of frequently touched surfaces such as counters, arm chair caps, touch screens, and divider screens. Mobile carts can support the proximate storage of cleaning products and additional PPE.
A quick and streamlined check-in process will increase consumer confidence and satisfaction. Where possible provide options to reduce or eliminate face-to-face encounters. Positive, friendly, scripted communication of new protocols, coupled with the successful management of seating density, queuing and cadence of patient rooming will improve the patient experience.
Leverage existing EMR systems by launching and promoting portal based check-in modules. Install check-in kiosks to read QR codes and allow patients to choose to complete Check-in without a face to face encounter. Consider allowing for insurance card and ID scanning as well as co-pay collection. Kiosks can be simple or robust. Engage your clinical IT team to choose the option that your site can implement effectively.
Maintaining appropriate separation while receiving essential services will remain an important mitigation strategy. Consider the addition of supporting tools including signage, floor decals, acrylic barriers, and other visual cues to remind and guide visitors to follow your protocols.
Provide prominent PPE Stations that accommodate trash receptacles. Consider providing mobile carts to keep necessary cleaning supplies at hand. Develop a protocol for cleaning before and after each encounter. Incorporate touch-less interventions.
Move patients to exam rooms directly after check-in reducing the number of patients in common areas. Consider implementing self-rooming, especially for experienced patients. If exam room capacity is not sufficient for immediate rooming for all patients, develop criteria for identifying special populations for immediate rooming (i.e. at-risk, immune suppressed, respiratory symptoms)
Patients will feel more comfortable if waiting zones are not crowded. When possible, space appointments and encourage patients to limit guests to one family member. Provide simple cues to reinforce ample space between patients including removing a percentage of seating. Consider the addition of freestanding screens to achieve separation.
Introduce Environmental/Biophilic Enhancements. Incorporate sound system for spa-like music or nature sound. Incorporate aromatherapy: clean, citrus scents which have broad appeal. Add portable humidification unit if building system can not achieve optimal humidity target range. If art is not already in place, add nature-themed imagery to create positive distraction and reduce stress.
Consider eliminating intermediate stops on the patient rooming pathway that require additional cleaning and safety measures by collecting vitals and confirming medication lists and symptoms in the exam room rather than a vitals or assessment space shared by multiple exam rooms.
Help promote increased hand hygiene by adding waterless sanitizer dispensers on both sides of exam room doors, developing clear signage reminding visitors of protocols and expectations, and scripting staff to remind patients at key steps. Consider adjusting the timed shut-off of hands-free faucets to 20 seconds to provide passive reminders of best practices.
Consider reducing the number of times a staff member needs to leave and re-enter the exam room during a routine encounter. Evaluate current supply par and adjust to ensure it is adequate to accommodate all routine supplies for a full shift to eliminate unnecessary movement in/out of the room.
Consider active and passive infection control interventions used in conjunction with enhanced cleaning protocols including self-cleaning keyboards, silicone exam stools, and hard plastic shell guest chairs. Combine these with enhanced cleaning at the end of each half day session. Consider hydrogen peroxide fogging at then end of each day.
Consider completing check-out activities in the exam room to reduce patient moves/sanitization steps. Team members could access scheduling functions and aftercare resources from the documentation station in the exam room. Consider adding printers in or near exam rooms to further reduce the need to leave and return during the encounter. Team members could also explain telehealth and online wellness education opportunities to support patients post-visit.
Our buildings have a tangible impact on our health. Indoor air quality, improved air filtration, impervious finish materials, plumbing interventions, and rigorous cleaning and infection control measures, when evaluated in concert with streamlined patient and staff work flows, have the potential to effect greater resiliency in our buildings, and in ourselves.
Consider adjusting HVAC systems, if feasible, to bring in more outside air, improve air changes per hour, filtration, and disinfection (polar ionization). Determine if air handling units are equipped with an economizer feature to bring in more fresh outside air. Confirm humidity levels are within the 40-60 percent ideal range to limit viral growth.
Where possible, install after-market, self-cleaning barriers to areas that are subject to high levels of touch (such as door handles and check-out counters). When combined with an effective cleaning strategy, these protective skins not only serve to improve environmental safety, but can help communicate your commitment to providing a clean and healthy space for patients and staff.
Consider replacing door and storage cabinet hardware with automatic and/or hands-free operators. Also, consider supplementing existing door hardware with hands-free "hook" pulls, hand wave sensors, magnetic door openers or door stops.
Initial studies indicate that the virus is spread by open toilet plume aerosol. In the short-term, simply replacing open seat rings with covered seats and adding signage instructing users to close the lid prior to flushing is an improvement. An ideal condition would be a flush valve that is actuated by closing the toilet lid; while this feature is currently only available on luxury residential fixtures, we would recommend monitoring the industry for future commercial product releases.
Improve infection prevention in your elevators through a combination of reducing utilization and enhancing safety. Consider activation of nearby stairs for those who are able (Assess condition: are they well-lit, are the rails and treads in good repair). Improve elevator safety by evaluating HEPA filter retrofit options and evaluating if controls can be programmed to avoid intermediate stops from lobbies to selected floors to limit mixing of patients & families.
The healthcare industry needs innovative solutions to battle the unprecedented coronavirus pandemic. Array Advisors, Array Analytics, and Array Architects will continue to provide ideas, design, and data-informed tools to help support their clients on the front lines of caring for our nation.