AMGA CMO Council: Staffing and Clinical Teams for COVID-19

AMGA COVID-19 Resources

This summary is based on a discussion via AMGA’s Chief Medical Officer Council listserv as of March 18, 2020. For more information about the CMO Council, please click here.

Common Approaches

  • Enable video and telephone visits as much as you can.
    • Have clinicians use their best judgement regarding in office visits.
  • Ramp down non-elective surgery, screening procedures, and testing—try as best as you can to get to essential services only.
    • Consider how you can redeploy PAs and physicians.
    • No febrile/URI visits in the usual practice locations.
    • Repurpose buildings: Convert as much as you can to COVID sites and consider one large site to see limited, essential non-COVID patients.
  • Develop a system RN/physician hotline to handle patient/community questions, with physicians backing up the RNs.
    • Provide algorithms for phone calls and sick calls
    • Decant calls from ED
    • Deploy RN from the population health team with physicians (who are FPs early in practice development and have less than full schedules) to help.
  • Drive-in testing/evaluation
    • Staffing is one provider in PPE, one staff (LPN or RN) who assists but not in PPE, and a scribe (MA or LPN)
    • Be wary of running out of test kits—know your limit
  • Establish an incident command center
    • Convert care management department to Covid-19 coordination team. Role is calling patients with results, reviewing quarantine instructions, converting visits to telehealth.
  • HR issues to beware of
    • Review your group's compact and communicate ahead of time your expectations of clinicians.
    • Requests not to see sick patients.
    • Returning to work after exposure.
    • Managing healthcare workers with PUI status at home.
  • For your teams
    • Consider deploying physicians who are 70+ years old or have immunocompromising conditions to non-office work—telephonic care, call centers, etc.
    • Split your office into teams of staff and physicians and rotate them in/out of the office.
    • Push out workflows to support documentation and billing for telemedicine permitted under emergency provisions/waivers (FaceTime for example).
  • If you’re not in the thick of it yet
    • Use respiratory clinics to try to keep these patients out of the rest of the care center (very difficult, patients deny symptoms until face-to-face with a clinician).
      • Greeters at all entrances handing masks to anyone with cough. Upper respiratory infection (URI) symptoms are sent to RN Triage for evaluation: Go to respiratory clinic or continue on to PCP in surgical mask.
    • Prepare radiology/imaging to determine which screening/follow-up tests they can safely defer.
    • Ask your departments to develop guidelines for what ambulatory visits and procedures they can safely defer.
    • Prepare for staffing issues when clinicians and staff are either ill or off while awaiting testing.