AMGA CEO Council Meeting: Clinical Guidelines for Ambulatory Assessment
March 24, 2020
This summary is based on a discussion via the AMGA’s Chief Executive Officer/Board Chair/President listserv as of March 24, 2020. For more information about the CEO Council, please click here.
Question: Have you assembled detailed service scripting and clinical guidelines on the approach to ambulatory assessment of influenza-like illness? There are struggles with how to be consistent in communication, test utilization (or not), and patient understanding in regards to how best to take care of yourself with mild illness that does not need an in-person visit or an ED visit.
- Use the Schmitt-Thompson protocol as a basis and have three authors who adapt to Centers for Disease Control and Prevention (CDC), state regulations, and availability of resources. Establish parameters based on history and symptoms. Keep an eye on the CDC website and be sure to participate in your county public health calls. Take your direction from your infectious disease professionals and the legal authorities, then adapt based on available resources (Urgent Care Center/video/car triage).
- Emergency Department and 911 calls are typical for people who are having respiratory distress or perceived illness greater than what you would see in a UCC or clinic. From the RN triage line, if the patient is high risk for complications and has symptoms, escalate to video. The video provides a higher level of assessment and is seen as a replacement for an in-person visit.
- For patients who are not high risk but are symptomatic and have a known exposure, send to video instead of to UCC. The UCC will determine if an in-person visit is required. For patients who are not high risk, not symptomatic, and with or without a known exposure, provide home care instructions. Have meetings one to two times per week to see what needs to be changed. Then change all documents (e-documents), SmartPhrases, and training, and communicate to the team providing advice and care. Key is forming a smaller group to change and adapt, then use wiki in Epic as a tool.
- Use a texting program to free up vital resources by providing COVID-19 education and support to your patients with this automated program. It provides information directly to patients which they would normally try to get by calling your offices, freeing up phones. Deploy a chat bot to your webpage and include COVID-19 screening algorithms for the general public (See tool example at caresignal.health/covid/esse-health). This helps people to navigate their concerns, screen for COVID-19, and then if appropriate, refer them to your Infection preventionists for further screening and consideration for testing. The same option should be available telephonically through a dedicated COVID line to help your community members navigate their concerns.
- Staff a dedicated Pandemic Response Center as part of your digital health platform as an extension of your Contact Center, with more than 50 nurses available around the clock for further screening, triaging, and referral to appropriate locations. Start identifying pandemic response workers from your labor force to aid in the distribution of home monitoring technology, etc. Have daily 7:00 a.m. calls with your physicians and APPs to share up-to-date information from your ministry, the state, and nation. Allow questions throughout and answer these or escalate for further information. This provides a sense of support and transparency that is quite critical right now.
Question: Do you have employed physicians writing orders for your employees to be off of work because the doctor has agreed with the person that they "are in a high-risk population for COVID"? How are you addressing this?
- Rely on a strong CMO. If you don’t have one, find a clinically respected physician leader who can intervene. The plan needs to emphasize the team, not individuals.