Kerin Torpey Bashaw, MPH, RN, Senior Vice President, Patient Safety and Risk Management, and Debbie K. Hill, MBA, RN, Senior Patient Safety Risk Manager

As state and local governments determine that criteria have been met to implement Phase One of the federal Opening Up America Again Guidelines, medical offices will begin reopening—and will need to make modifications to keep patients and office staff safe. Though the dynamics surrounding COVID-19 will continue to change in the weeks and months ahead, what must not change is physicians and medical office staff remaining vigilant.

We've heard from physicians that they are concerned about the risks involved in reopening their practices. In response to these concerns, we offer the following 10 recommendations:

1. Provide refresher training for all staff on triage, infection control, use of personal protective equipment (PPE), and patient communication.
2. Determine staff needs for PPE based on levels of infection in the community, types of patients seen, and types of patient care procedures performed. See guidance from the Occupational Safety and Health Administration (OSHA).
3. Contact your insurance agent or medical professional liability carrier to confirm that coverage has been reinstated at the desired level if you have requested adjustments in your professional liability coverage during the crisis.
4. Schedule in-person visits according to medical priority. Consider continued telehealth visits for patients at high risk for COVID-19 who don't need to be seen in person.
5. Follow guidelines from the Centers for Disease Control and Prevention (CDC) for patient COVID-19 screening upon appointment scheduling and on day of appointment.
6. Avoid patient-to-patient contact by considering separate entrance and exit doors, limiting capacity, asking patients to wait in the car, and allowing only one-patient visits. If patient must be accompanied, screen chaperone for COVID-19. See the CDC's Outpatient and Ambulatory Care Settings: Responding to Community Transmission of COVID-19 in the United States.
7. Assess whether public, work, and treatment areas are equipped to reduce the spread of COVID-19. For example, use Environmental Protection Agency (EPA)-approved cleaning chemicals with label claims against the coronavirus. For more information, see OSHA's Ten Steps All Workplaces Can Take to Reduce Risk of Exposure to Coronavirus. For a list of disinfection products effective against coronavirus (COVID-19, also known as SARS-CoV-2), see the Environment Protection Agency list.
8. Screen healthcare personnel daily for symptoms/travel/contacts relevant to COVID-19. Any unprotected occupational exposure by staff members should be assessed and monitored. See Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19).
9. Follow return-to-work guidelines for healthcare workers with confirmed or suspected COVID-19.
10. Maintain an open line of communication with all vendors and supply chains for infection control purposes and access to available resources.

Concerns will persist regarding the possibility of COVID-19's resurgence as state and local governments implement the phases of the Opening Up America Again Guidelines. We urge you to:

• Reference the CDC, your state medical board, professional societies, and federal, state, and local authorities daily for public health guidance and new legislation. The CDC provides public health agency contact information at National Voluntary Accreditation for Public Health Departments.
• Be mindful of expiration dates of executive orders related to licensing, telemedicine, prescribing rules, and regulatory compliance. See COVID-19: Executive Orders by State on Dental, Medical, and Surgical Procedures for a list of state executive orders from the American College of Surgeons.

We've provided these tips because we are driven by our mission to advance the practice of good medicine. As always, use your best clinical judgment. Continue to be diligent and proceed with caution as you manage patients within your facility. Stay abreast of community incidence of disease and restructure your approach when needed.