Q&A: Reopening Safely

Safety is a huge concern for physicians reopening their doors during the coronavirus pandemic. In our webinar, “Best Practices for Reopening the Private Practice Amidst COVID-19,” we fielded more than 90 questions from our audience. Those questions about safety that we did not answer live are answered by our panelists here.

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Q: Are you going to require patients to wear an N95 mask or better, or will you let them wear any old homemade mask?

Morgan Curry, RN, BSN, Associate Nursing Director, Waldman Schantz Turner Plastic Surgery Center: “It is not necessary for a patient to wear a N95 mask. The patients are required to wear a cloth mask or surgical mask which they must bring from home. If they come to our lobby without a mask, one will be provided for them. (The patient will be educated in email form of all of these procedures they must abide by prior to their apt).”

Q: I am concerned about HCW to HCW transmission in the office. Are you requiring all staff to mask and also socially distance? Or just suggesting? Some staff have declined.

Curry: “All staff is required to wear a mask during the day, and we are all social distancing as much as possible. This is not only a recommendation by ASPS but also our accreditation body (AAAASF). As well as our state government. I would not make this an option to the staff at first at least until the dust settles and we begin to see a steady decline. It is also a visual sign to your patients that you are making a continuous effort to also protect them when they are in your environment.”

Q: Suggested protocol if you get a call from a treated patient who is diagnosed with COVID-19 days after seeing you or if you get a staff member who tests positive — Who needs to be notified? Implications for rest of staff/ staying open?

Curry: “We have not developed a protocol for this...good question...I hope this does not happen.”

Q: Morgan mentioned something about a questionnaire and having patients review and sign it. Will you be including this info in the chart? Especially taking the temp?

Curry: “Yes, I have a questionnaire that we are using in clinic and our surgery patients are also required to fill it out. I will attach the document to this email.”

Q: Check-in protocols clipboards/Ipad’s to reduce transmission via fomites?

Curry: “Check in protocol: New/updated patient paperwork will be sent via email and they will fill it out prior to their in-office appointment.We have the capability with our E-MAR system for it to download into our system. We will have a nurse downstairs for check in with masks, gloves, and sanitized pens. If a patient does not fill out their questionnaire and send it back into us prior to their appointment, they will be required to answer the questions in our lobby before entering the elevator to our office. The temps will be via laser thermometer to decrease touch surface. The nurse will record the info and it will be placed in patient note for visit.”

Q: What is your suggestion for employees being in the office and keeping them 6 feet apart?

Curry: “Fortunately, our office is very spacious, so we are each sticking to our own individual workspaces/offices/etc. as best as we can. There will be small exceptions to this rule such as in exam rooms etc. All staff will be required to wear masks at all times throughout the clinical day.”

Q: There are conflicting statements from state and local governments about whether it's okay to return to elective procedures/surgery. How best to handle these discrepancies?

Curry: “I think everything is constantly fluid and changing. You must take everything day by day. I would suggest that you formulate the majority of your policy as to when to begin based upon your state government. For example, Kentucky's governor holds daily press conferences that outlines what changes daily. It is important to remain up to date on the changes.”

Q: Changing rooms have the highest concentration of virus. Where will your staff change [into and out of scrubs] and won't that create additional issues?

Jason Pozner, M.D., Plastic Surgeon, Boca Raton, Fla.: “[Staff is changing] in the bathrooms, which are wiped down after each entry.”

Q: How about restrooms use for patients in office? Can the bathroom be “out of order,” especially since there is no waiting time as waiting room is pass through only?

Dr. Pozner: “Same [as above] - wipe down after each patient.”

Q: Where do you purchase one of these PAPRs like Dr. Ivan Wayne is demonstrating?

Ivan Wayne, MD, Facial Plastic Surgeon, Oklahoma City:“These are hard to find. Anything by 3M is good, adlfo or TR300 series with a hood or helmet. Ebay is another good place to look.”

Q: Where did Dr. Wayne get his OR equipment from?

Dr. Wayne: “I had this from before the pandemic (it is part of my welding/metal sculpture gear).”

Q: Can you wear loupes with that get up?

Dr. Wayne: “You can wear any glasses under the hood.”

Q: How do you clean the masks after usage?

Dr. Wayne: “I wipe off the outside with standard OR cleaning wipes. It is no different than your glasses or hat. Unless is gets splashed it is low risk and easily cleaned.”

Q: Ivan can you mention the company and model of your OR mask?

Dr. Wayne: “Mine is 3M versaflo TR600.”

Q: Can Ivan tell us who he’s using to do the in-office nasal swabs? Are they a send out?

Dr. Wayne: “I do the swabbing myself and we send it off. Very easy to do. We get 24-hour turnaround.”

Q: What if as a provider you’re not concerned... (ie. Already had it or likely had it). Same as most of my staff… our community had an outbreak in Feb... do we really have to wear all this gear?!?

Dr. Wayne: “Well, if you have a serum test with high antibody titers of IgG you may be protected. That is a question for an infectious disease specialist.”

Q: Are you planning on reducing the number of patients you are seeing per day/week?

Randolph Waldman, M.D, Facial Plastic Surgeon, Lexington, Ky.: “We are mandated to cut our volume of surgery and we must engage in social separation which by its very definition requires us to cut our patient visits in half, but we will make up for it with virtual visits and virtual consults which have been increasing.”

Q: How do you suggest deciding when to start opening to non-urgent patients?

Dr. Waldman: “As soon as the governing authorities allow.”

Q: Given the obvious 50% or so cut in patient volume, how do you foresee your ability to survive financially over the next six months?

Dr. Waldman: “We are fortunate to have our own ORs and a huge back log of patients. We only receive 15% of our income from injectable fillers. Skincare brings in another 5%. 80% is from Surgery and we expect surgical demand to stay steady into the fall so income should stay adequate for 2020 and then with a potential vaccine we feel good about 2021 unless a significant recession takes place.”

Q: How are nasal/perioral/oral procedures being handled? What protocols should we implement?

Dr. Waldman: “Very difficult issue. We will protect with N95 and also visors and of course preop testing (not totally reliable) but honestly, I personally prefer waiting until we see an announcement by the governor that no new cases have been reported in our area for the past several days. Ultimately a vaccine is the only thing that will allow us to have the ultimate comfort level.There should be no rush into action especially for those of us over 60. We also want to make sure our staff is comfortable with everything we are doing as no one wants to get this terrible illness.”

NEXT: Q&A: Testing for COVID-19