PracticalDermatology

As local governments allow non-emergent medical and aesthetic practices to re-open, you may be concerned about protecting yourself, your team, and your patients. Now is the time to prepare your dermatology practice to successfully emerge from COVID-19 shutdowns. Formulate your plan and take your time. Communicate first to your staff and then to your patients. If you instill confidence in your team, you set the stage for a positive experience for everyone. Consider the following steps for a smooth, safe reopening.

Focus on Hygiene

Take your safety and hygiene practices to the next level. To ensure the safety of your staff and your patients, we encourage you to adopt the following measures.

Add to Your Practice Policies:

1. Employee Health and Safety Plan

2. Office Cleaning and Disinfecting Plan

3. Phone Communication Plan

4. Patient Visit Safety Plan

5. Telederm Patient Consent

6. In-Office Patient Consent: COVID-19 Pandemic addendum

Consider brainstorming with your entire team to create safety procedures. Have your front desk member act as a sample patient as well as in his or her administrative role. Have your clinical care team members then act as the model patient and also in the front desk role. By walking through a sample patient encounter, your team will often find overlooked safety measures. We suggest having each team member carry notepads to write down observations/ideas and then formulate their individual checklist. You and your office administrator can then review and compile a master policy.

Once you have updated your guidelines, hold a staff meeting. Review the health and safety procedures, and then have all employees document that they were trained properly. This highlights everyone’s responsibility to properly prepare. Remember to ensure staff members follow social distancing in break rooms. No more eating at one’s desk or at the nurses’ station as each of your team members should be wearing appropriate PPE in clinical areas.

Human Resources

Decide which staff members are essential to reopening. Create a schedule identifying who will be part-time and/or if any remote work options are available. Consider staggering clinical staff schedules so you have two or three teams to help with in-office patient care while the other team(s) are helping with telemedicine tasks, including pre-authorization calls and prescription refills.

• Ensure staff knows to stay home if they have any COVID-19 symptoms, such as a cough, loss of taste or smell, pernio, or fevers. Have them review the CDC’s Return to Work Criteria.
• Check in with employees at the beginning of each day to determine if they have flu-like symptoms. Also consider non-contact temperature screening once or twice daily for each team member. If you choose to do this, you will need to establish a baseline “normal” temperature for each staff member.
• Accommodate staff schedules when possible. Be aware of childcare issues, ongoing school closures, and other matters that might prevent your employee returning to the office. Be creative! Can you job share for those team members who are having difficulty with home care? These members can still be productive by calling in refills, answering patient questions, and helping with preparing patients for his/her upcoming office visit.
• Have a specific protocol in place for staff members who have become ill or have been tested positive for COVID-19. What are return to work criteria?
• Be clear about PPE and sanitization for staff.

Prepare the Office

Be ready to increase safety and hygiene practices for your opening. Be sure to review and implement your government guidelines. Most new guidelines are universal and include:

• Physical Barriers (plexiglass at check-in and check-out areas to protect your team and the patient)
• Waiting Room Changes (remove or spread apart chairs, remove magazines, remove the patient coffee and snack station, TV remotes, etc.)
• Exam Room Changes (remove extra seating, as patients should arrive alone for their visit; add plastic bins for patient belongings, touchless hand sanitizer dispensers, Lasercyn [Sonoma Pharmaceuticals] to sterilize patient hands, face, and devices, Cavi-wipes to sanitize work and patient surfaces; remove computer keyboards, pens, remotes, etc. if possible)
• Minimize patients touching surfaces of your office. Have each patient check-in from their car and wait to be escorted in by your team member. The patient should not have to touch your door handles. Encourage patients to use the restroom before coming to or entering your office.
• Wipe down all doorknobs, cabinet handles, seating surfaces, work surfaces, trash cans, light switches, etc. before and after each patient. You may consider having a “Clean” and “To Be Sterilized” sign to put on the outside of each room to easily allow your team to communicate and to let your patient know your safety measures.
• Consider initially offering only services that require minimal physical contact (i.e., no facials or massages).

Follow all OSHA and CDC guidelines.

Start with a half-day schedule for the first two to three days to review your protocols and adjust as needed. You will also need to have a reduced schedule to minimize patient waiting and allow for sterilization of patient rooms after each visit. Gradually increase hours or patients per hour as you adjust to the new normal.

From a business (and safety) perspective, one of the best things you can do is reduce the amount of in-office paperwork. Consider emailing new patient forms to prospective clients. With today’s technology, these forms can easily be filled out via mobile devices or computers and easily imported into the patient’s chart. Utilize your EMR patient portals for established patients to have that person confirm accuracy of her/his contact data (make email address entry mandatory), insurance information, and current medical history. Now each patient can be seen immediately upon arrival to your office with no delay and no touching of your pens or devices.

Focus on Patient Experience

Share and educate your patients about changes in your practice. Provide assurance as well as relevant information for your area. Consider a consent form for patients that informs them that we don’t know the effects of having procedures during this uncertain time. New steps you will want to consider in managing patients include:

• Communicate new procedures and any changes in hours, services offered, and safety guidelines.
• Check in the evening prior to the appointment to ensure your patient has no symptoms. Most offices include questions about fever, travel, exposure to COVID-positive friends or family members. Don’t forget to directly ask your patient, “Have you been tested for COVID? What are your test results?”
• In addition to pre-screening patients, make sure all paperwork is completed before the patient’s arrival.
• Consider using a screening tool, such as temperature and/or O₂ saturation for each patient upon arrival. You may want to re-ask the questions noted above.
• Implement a one-person-per-appointment policy; consider having them wait in their car until they are invited in.
• Practice social distancing with all patients.
• Offer telemedicine. Telemedicine may actually make your office more efficient in the future.

Share a video of your modified office experience (see the Refresh Dermatology video at refreshdermatology.com). We send this link to each patient when confirming appointments.

Every jurisdiction will have different rules for reopening. Common guidelines should be obeyed, but you may want to take additional measures for the comfort and safety of your staff and patients. Provide additional guidance and signage to emphasize new safety measures so that it is clearly stated. Take care of yourself while you begin the reopening process.