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