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. o Prepare for staffing issues when clinicians and staff are either ill or off while awaiting testing.
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