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Coping in the Ever Changing COVID 19 Health Care Environment

Coping in the Ever Changing COVID 19 Health Care Environment
By Tina Fawns, MD

During the current COVID 19 environment, things are very different from what patients previously experienced at UK Health Care, Family Medicine Clinic at the Turfland site on Harrodsburg Road.   All staff are in masks throughout the building and even some in face shields at the check in and check out regions. Registration is being encouraged to take place from one’s vehicle by phone for clinical visit, lab, and x-ray. Signs in the parking lot directing patients to call various numbers to connect to their desired clinic. All patients are encouraged to have lab or x-ray appointments. Walking in for labs or diagnostic testing no longer encouraged.  If they do walk in, they will be scheduled an appointment and encouraged to go back out to their vehicle to wait. After vehicle registration, the patient will be called in to be escorted directly to the exam room by a CST or nurse or to lab/x-ray via technician. Meanwhile, nursing staff are trying to balance calling results, assisting with paperwork, answering patient concerns, and rescheduling patients to telemedicine who are high risk. Providers are still held to meeting certain dashboard goals for quality and nurses asking questions targeted to these quality measures in order to assist providers of the facility in getting better reimbursement from insurance.

Some patients still prefer to come in to register due to language barriers or hearing impairment, lack of a cell phone, or are utilizing public transportation. For these individuals’ certain seats are blocked off to promote social distancing. Registration still taking place at the entrance, with some staff focused on answering phones, while others are dealing with those who have chosen to come in. Those who chose to enter the building may still be found in the waiting room in designated areas.  All those who enter without a mask will be offered and encouraged to wear a mask during their visit. The system is in constant flux trying to promote safety while continuing to provide care to patients.

When patients register, they will be asked questions targeted to COVID 19 symptoms or risk of exposure. At some offices your temperature might even be taken.  These questions of course coming in addition to the routine questions regarding insurance, contact information, and provider to be seen.  If there is a concern of possible infection of COVID 19, you will be taken to a designated hallway and directly to a room as well. The primary goal being to have these patients transferred for urgent care evaluation. Despite expediting them to a room quickly, they must wait until can be seen in order of arrival. The best scenario being that they call for an apt due to concerns about COVID 19 symptoms and scheduler sets them up with urgent care via telemedicine. If clinically stable, sent for covid testing via drive through behind building. If not clinically stable to be sent to the Emergency Room, where negative pressure rooms are available.  In the Emergency Room, Negative Pressure rooms provide a safe environment where the patient can receive albuterol nebulized treatments without aerosolizing virus and promoting further spread. They can be monitored for oxygen needs and possible admission to negative pressure rooms in which ventilation is self – contained.  If their clinical status is questionable then to come into urgent care clinic for further assessment prior to decision about disposition.  

Prior to April 27, only urgent /emergent patients were seen in office and the remainder seen via telemedicine either by zoom function or telephone calls. Being that there are some patients not having internet access or i-phones, a phone call continues to be the only means to discuss their medical needs and concerns. The nurse calls prior to the telemedicine appointment and ask the patient to take their own vitals, assess their medication bottles for refills, and discuss the progress of their care. A considerable amount of the clinic population are very happy with telemedicine and want to continue with telemedicine given the risks of exposure. This especially applies to the elderly, those with chronic lung conditions, diabetes, cardiac patients, and those with either immune compromise or on medication that cause such a state. These high-risk individuals are still encouraged to continue telemedicine as their primary means of care. Given the high mortality of the disease, safety is the utmost priority. It will be useful to monitor the trends of the illness as the clinics are opening to see the success rate of measures taken to ensure safety. This data will give more insight as to when those at higher risk should be able to return to be seen in the office.

 Caring for patients via telemedicine continues to provide a wealth of knowledge about the patient. You are better able to understand an individual’s home dynamics and living quarters. By seeing he or she in this respective manner, you can assess their physical overall wellbeing as well as mentation and coping skills given the current pandemic and quarantine.

Employees are required to answer a questionnaire on their phone or via paper when they enter the building prior to being emitted to the building. Employees only permitted to take off their masks in the lunchroom while eating or when closed in a room on telemedicine screen. Symptomatic employees scheduled for testing and required to stay home until cleared.

While the nursing staff have been wearing scrubs on a routine basis, there has been a discussion of the clinical providers wearing scrubs to change out of each evening prior to going home. This being even more important as we start opening our doors to more individuals being seen in the office.

Due to financial strain on our institution, our employees were and continue to be deployed to other departments, causing a shortage of staff and placing more taxing workload on the nurses left behind.  Leading to delays in expediting patient care and placing more demands on the providers to help with the cumbersome load. The employees deployed find themselves working odd hours that they are not accustomed to and in areas of which they are not experienced. While even other employees placed on furlong. Our clinic department found a means of avoiding putting staff on furlong, but many others did not.

The medical students of our clinic have been absent since the start of the quarantine. We anticipate their return next semester. Getting them acquainted with the new policies and procedures will take some time. Also providing them with the technology to start zoom meetings and teaching them the means of documentation necessary for these types of visits to be billed will be a learning curve as well. Residents have continued to practice, much in the same way. They have been utilizing zoom from very early in the process.

It has been a challenge for our patients in respect that diagnostic testing, elective procedures, routine labs, and clinic referrals were put on hold from Mid- March until the last week of April. Only emergent needs considered. As more offices and testing abilities are opening to the public for routine care, many tests and referrals are backlogged. Clients having to wait patiently to get needed care. As health care providers and facilities continue to strive for safety and flexibility in our care, we hope our patients can learn to be flexible as well during this ever-changing process.