COVID-19: Immediate Action Steps from the Front Lines
Updated March 19, 2020
We asked five AMGA members who are on the front lines of COVID-19 in some of the hotspots (Seattle, New York, and California) for their advice and things they wished they had known or done two weeks ago. Here are some of their suggestions:
Laboratory Testing and Screening
- Order as many of the specific swabs required for COVID-19 testing (UTM) as you can now.
- Work with your reference labs to get test shortages cleared out or identify labs that can process the tests.
- Consider setting up drive-through screening and testing.
Personal Protective Equipment (PPE)
- Tight controls and inventory management by Quality/Infection Control teams have been critical.
- Conduct daily counts of all types of masks, gowns, and googles.
- Daily check-ins on PPE to project when you might run out and have a point of escalation.
- Supply Chain leaders need to leverage existing relationships.
- Adapt to cloth, reuse as you need.
- Order as many masks as you can possibly get right now.
- Your County Public Health Departments may have access to reserves. Have a single point of contact for these requests so not everyone is calling.
- Follow guidance from CDC on use of PPE. Do not distribute PPE because of need to conserve for the long term.
- Set up a separate Nurse Triage
Line focused solely on COVID-19 to handle incoming calls. The other phone lines
or your urgent cares will otherwise be overwhelmed.
- From the RN triage line, if the patient is high risk for complications and has symptoms, consider escalation to video. The video can provide a higher level of assessment and is seen as a replacement for an in-person visit.
- ED or 911 for people who are having respiratory distress or perceived illness greater than what you would see in an Urgent Care or clinic.
- Ensure that there is one protocol and have tight change management processes in place. Support it with a SmartPhrase.
- Determine where car triage can happen and ensure the flow of traffic can be accommodated.
- Set up your COVID-19 ED tents/cabanas now.
- Institute the strictest inpatient visitation policy you can.
- Stop all elective surgery to preserve inventory.
- Have dedicated physicians who are not going into the clinics but will stay seeing inpatients while separate physicians cover for in-person visits at the clinic. Goals is to prevent a physician seeing patients at the clinics then going straight to the hospital and potentially infecting an admitted patient.
- Institute immediate front-door screening and require everyone to funnel through it. Consider separate entrances for employees and patients.
- Consider setting up triage, testing, and video visits in cars.
- After screening, if there is chance of infection, evaluate if they really should be in the office. If they need to be, they should have masks, use hand sanitizer, and be isolated.
- Go live with virtual visits for all ambulatory providers. You’ll need time to obtain and develop the technology and the right equipment. Train and trouble shoot telehealth early on. Technology often doesn’t work when you need it.
- For patients > 65 and high-risk conditions, evaluate what is the appropriate setting—video, telephone, in person. Consider if delaying care is an option.
- Patients need care, and systems need to be put in place to not expose high-risk patients to other patients who have COVID-19 and are asymptomatic.
- Postpone routine and non-essential care when appropriate.
- Limit visitors for both the clinic and hospital. Screen all visitors via a series of questions.
- Stand up a COVID-19 employee exposure helpline and clinic. Stand up a call-in number for furlough management.
- Provide a call-in number for clinicians to query CMOs for guidance on clinical care.
- Figure out your daycare plan for staff with kids who don’t have options with schools being closed.
- Allow telework for all staff who don’t need to be in the building.
- Get IT/IS working now on laptops and telephones for clinical staff who need to work from home. Second priority is having IT support for non-clinical staff to work from home.
- Create schedule management tools for clinicians to have time off to recharge.
Communication and Decision Making
- Executive leadership is 7 days per week. Develop leadership schedules for “lead” on every level for the next two months.
- Redirect all resources to focus on COVID-19, including cancelling all standing meeting, unless they can be easily repurposed to COVID-19.
- Develop policies and standards and then communicate them orally through the incident management team telephone huddle. Allow time for managers to ask questions—they will have them.
- Message to staff: The plan is evolving and will change as needed.
- Create two structures: Decision
Making; Problem Solving
- Problem-solving groups need to understand from the front line what is happening related to a topic and create potential solutions to bring to leadership teams.
- Decision-making teams meet less frequently, but make decisions based on the options brought by subject matter experts/problem-solving teams.
- Shore up your cash flow and get your banks to provide lines of credit.
- Don’t be afraid of making tough decisions.
Thank you to the AMGA members who contributed their experience to this list. Many of these topics also have arisen in our Leadership Councils Community pages. If you are not a member of an AMGA Leadership Council and would like more information, please contact Joe DeLisle, email@example.com.