Operational Considerations During COVID-19

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  1. What are the goals in optimizing practice operations?
    • Reduce the risk of infection and spread of COVID-19
    • Patient safety
    • Care team safety
    • Conserve and protect our critical workforce
    • Keep patients at home
    • Preserve access to care
    • Rapidly adapt to changing facts and events
    • Communicate regularly to all affected stakeholders
    • Use current experience to drive future care transformation
  1. How should office structure and function be addressed?
    • Move to a single point of entry
      • Screen all patients, visitors, and staff (including physicians)
      • Consider temperature screening before clinic/facility entry
    • Limit potential exposure
      • Reduce the number of individuals in waiting rooms
      • Stagger appointments and restrict visitors
      • Consider moving necessary in-office visits to off-campus (non-hospital) sites
      • Limit patient exposure for high-risk individuals
      • Try and maintain a distance >6 feet where possible
    • Reorganize staff
      • Reduce, redeploy and repurpose
      • Have all administrative staff work remotely if possible
      • Take an inventory of what other roles staff can play (even outside the service line)
    • Rethink access
      • Move as many encounters to be virtual
      • Consider temporarily closing and consolidating offices in close proximity
      • Consolidate days of service at outreach offices/clinics
    • Identify tests and procedures that can be deferred
    • Consider policies for issuing "excuse from work" letters for high-risk patients
    • Perform daily huddles and operational reviews
    • Provide targeted communication
      • Have a "chain of command"
      • Don't overwhelm with too many attachments/details
  1. How should patient scheduling be changed to meet goals and clinical demands?
    • Attempt to see all new patients with rare exception (e.g., elective pre-operative evaluation)
    • Maximize use of virtual care where possible
      • Understand the different types of virtual visits (e.g., video, telephone, e-consults)
    • Review current schedules days in advance with a goal of identifying established patients that:
      • Can be safely rescheduled >3 months
      • Can be seen virtually for active issues
      • Must be seen face-to-face (traditional visit)
    • Stagger or space out appointments to reduce the number of patients in the office and waiting areas
    • Limit office testing for those required for active clinical decision-making (no surveillance testing)
    • Document triage decisions, disposition, and type/timing of follow-up for liability purposes
      • Use shared decision-making whenever possible
      Plan for future scheduling adjustments needed to accommodate deferred visits
  1. How should physician and APP deployment be optimized?
    • Reduce the number of physicians, APPs, and clinical staff in the office
      • Consolidate schedules – Practice zone defense
      • Create teams (physicians/APPs/clinical staff) that are restricted to remote duties 1 week at a time so as to avoid group exposure
        • Particularly important for "mission-critical" physicians (e.g., interventional cardiologists, cardiovascular surgeons and intensivists)
        • Rotate these "home teams" with "on site teams" on a weekly basis
        • Attempt to keep those at increased risk (e.g., immunocompromised individuals) on a "home team" until risk is mitigated
    • Leverage "home teams" to do:
      • Virtual office visits
      • Reading of remote diagnostic studies (e.g., echocardiograms)
      • Phone/triage support
    • Minimize duplication of visits by subspecialty cardiologists where possible (e.g., general cardiology, EP, heart failure)
    • Take PTO as scheduled unless dictated otherwise by workforce shortage or surge demand
    • Recognize and mitigate "burn-out"
  1. How should hospital needs be met?
    • Attempt to consolidate coverage (use shifts)
      • Accommodation will be needed for higher risk physicians, APPs and clinical staff (e.g., immunocompromised, chronic illness)
    • Identify tests and procedures that can be deferred
    • Make every attempt to reduce the hospital census – free-up beds
      • Attempt to prevent "unnecessary" admissions
      • Re-evaluate transfer criteria
      • Adjust procedural schedule to 7 days per week to facilitate discharges
      • Emphasize same-day discharge post procedure
      • Expedite discharges with early virtual follow up
  1. What are the compensation issues that need to be addressed?
    • Staff
      • Ensure support
        • Address work hours (guaranteed vs. reduced)
        • How to redeploy and repurpose
        • PTO, sick leave, etc.
      • Keep staff engaged to be able to ramp-up as the crisis dissipates
    • Physicians and APPs
      • Anticipate/estimate reduced production and compensation
      • Attempt to protect base compensation with adjusted wRVU targets
        • Independent clinicians – Consider shared group revenue model
        • Employed clinicians – Consider shared distribution model
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This article is authored by Edward T. A. Fry, MD, FACC.

Clinical Topics: COVID-19 Hub

Keywords: Cardiology Magazine, ACC Publications, COVID-19, Coronavirus, Coronavirus Infections, Patient Discharge, Patient Safety

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