Reopening Your Practice During COVID-19: Risk Management Guidance



 

Summary: As practices begin to reopen to offer elective, nonemergent, non-COVID-19-related care, the reality is, healthcare will not be delivered in the same way it had been pre-pandemic. It is of utmost importance to consider various risks and how to mitigate them before reopening a healthcare facility or medical practice to help ensure the safety of patients, healthcare professionals and their staff.

The issue:

Many healthcare facilities and medical practices have had to close or drastically cut back on seeing patients during the first few months of the COVID-19 pandemic. As healthcare professionals prepare to resume operations, it’s important to consider the many changes that have occurred, and how they can impact your practice. Taking the time to think through how to best begin this process, and implementing a plan, will pay off in the long run.

What are the risks?

  • The virus continuing to spread: It goes without saying that bringing people together (such as in a typical waiting room) can drastically increase the likelihood of COVID-19 spreading. This is a chief concern when reopening a healthcare facility or medical practice during this time.
  • Breakdown of systems and processes: How facilities and practices operate is, in many ways, considerably altered. This likely means that some existing tracking systems or other processes and protocols may no longer work as they originally did – particularly if you are operating with reduced staff or if some employees are working remotely. This could result in tests falling through the cracks, follow-up being overlooked, and other patient safety issues.
  • Poor communication with patients and other members of the healthcare team: If changes to the practice workflow and other processes are not communicated effectively to patients and team members, important information can be lost – which can result in serious safety implications.
  • Gaps in patient care: Many patients, including those who require treatment for chronic conditions or who are experiencing worrisome symptoms, may have deferred scheduling their appointments longer than is customary. Even after facilities and practices reopen, it is possible that this trend will continue as concerns surrounding COVID-19 persist.
  • Increased rates of burnout: The pandemic has significantly increased the physical, emotional and mental demands on healthcare professionals and staff, increasing the risks to patient safety, quality of care and healthcare professionals’ wellbeing.1

    What can you do?

    With guidance on COVID-19 ever-changing, be sure you are keeping current with recommendations from public health departments, healthcare authorities, specialty societies, as well as local, state and federal governments. In particular, make sure you are aware of your state’s current guidance and restrictions on reopening your practice or facility. That being said, many core risk management strategies remain the same.

    As you prepare to reopen your practice, you’ll want to consider doing the following:

    • Examine your processes and systems. It’s likely that the way your facility or practice operates has been – and will continue to be – impacted by the pandemic. You’ll want to make sure that the protocols and processes you have in place will continue to function effectively.
      To start, you might want to review how your facility or practice actually operates – and what’s necessary to keep your patients and staff safe. Here are some questions you may wish to consider:
      • How will you ensure adequate personal protective equipment (PPE) for staff?
      • Are there staffing considerations? How will you handle employees who are at an elevated risk for COVID-19 or those who may have unique family obligations? How will your processes be affected if physicians or staff become sick?
      • Are there administrative functions (e.g., accounting, HR, etc.) that can be handled remotely?
      • Will you screen staff and patients for symptoms of COVID-19 prior to entering the facility or practice? How?
      • What will your guest and visitor policies be? For example, who will be allowed to accompany patients to an appointment? Will there be separate processes for sick visits versus well visits? How will your waiting room be configured to comply with any social distancing policies?
      • How will you address other business needs? For example, are support services such as cleaning crews available as before? Will enhanced cleaning be done? Are there coverage concerns that need to be handled? If you previously contacted your broker or an ISMIE underwriter to modify your coverage, make sure your current policy is appropriate as you reopen.
      You’ll also want to review your clinical processes. You might consider the following:
      • What will be the process for making, confirming and scheduling appointments? How will you ensure appropriate triage via phone, when necessary?
      • Have your processes for test tracking or follow-up changed?
      • How will referrals be handled going forward?
      • Once patients arrive at your facility or practice, what will the intake and triage process look like?
      • How will you ensure adequate sanitation throughout your facility or practice?
      Overall, ask yourself: Are your processes still sufficient? Do you need to make any updates to help ensure high quality and safe patient care? Do you need to involve other stakeholders to make any changes?
    • Determine your scope as the pandemic persists. Figure out what you are and are not comfortable treating during this time. What care can you safely and reasonably provide at your facility or practice and what can still be addressed via telemedicine or perhaps rescheduled? If you are uncomfortable providing specific types of care in the office, do you have a backup plan in place? For example, will you be referring treatment for certain conditions to another healthcare professional?
    • Decide how best to communicate with your patients. The importance of clear, useful communication with patients cannot be overstated. You’ll want to think about how you can communicate the following to your patients:
      • When your facility or practice will be reopening
      • Any changes to hours, if applicable
      • Who should come into the facility or practice and who can still utilize remote appointments
      • Who can physically enter the facility or practice (e.g., only the patient, patient and one caregiver, etc.) and whether they will be screened
      • Updated processes or protocols they need to know before they visit your facility or practice
      • What is being done to keep patients and staff safe (e.g., any increased sanitization efforts, mask requirements, etc.)
      • What can be done to educate your patients on the importance of following PPE protocols and other safety measures?
      If your facility or practice has a website, sharing some or all of this information there might be an effective way to convey it to your patients. It might also be useful to have this information available as a handout for when patients arrive at your practice or facility.
      Also consider how you might employ patient education tools to help your patients understand COVID-19 and what they can do to minimize the risk of catching or spreading the virus. You can create your own education; however, there are organizations with patient education resources already developed that you might find useful. These include:
      In addition, you might consider including any reasons why you are taking particular actions. This can help patients understand why they are being asked to do (or not do) certain things, which can help improve adherence.
    • Communicate with staff and other clinicians. As practices and facilities establish new ways of providing and facilitating patient care, it’s important to make sure that everyone – from patients to members of the healthcare team – understand these changes. Make sure your staff know what to expect as they return to the office and encourage them to participate in the discussion if they have any suggestions or ideas. For example:
      • Will there be any additional education or training?
      • Are there any new screening processes?
      • What has changed at the practice?
      Consider instituting a routine team huddle if you hadn’t used them before. With information and guidance changing so quickly, this is a helpful way to help ensure that all members of the team are on the same page at the beginning of each day. Remember, all clinicians and staff should be following any necessary safety protocols if these meetings are held in person.
      Be sure you understand if any processes have changed with other healthcare professionals, vendors or facilities with whom you often work. For example:
      • Did the lab adjust their hours?
      • Does your local hospital have a modified intake process for non-COVID-19 patients you need to know about?
      In addition, confirm there will not be a disruption in service with your various facility or practice support partners (e.g., cleaning crews, laundry services, etc.).
    • Document your efforts. Be sure to document any education or training you provide to your staff or any contact you’ve had with other physicians, clinicians, facilities and practices regarding their updated processes. You should also document any rescheduled appointments. You’ll also want to document your reasoning as it relates to any instructions you’ve given to the patient about whether they should – or should not – come into the facility or practice for their appointment.
    • Exercise empathy.2 This is without a doubt a challenging and stressful time. Being empathetic will help ease the effects of burnout for healthcare professionals and will help patients feel safe. Don’t forget to be kind to yourself as well – this can help to lessen the symptoms of burnout. Visit ISMIE’s Wellness Center for information on how we support our policyholders as they navigate the demands of the profession.
    • Allow for flexibility. The demands on your facility or practice may look a lot different than they did before the pandemic. Stay flexible to accommodate a potential steep rise or lull in patients contacting your facility or practice. Be sure to keep lines of communication open as you navigate a reopening.

    Wrap-up:

    There are still many unknowns regarding COVID-19 and how the country (and world) will move forward. As healthcare facilities and medical practices begin to reopen, it’s important to understand the risks that are present and how to best mitigate them in order to provide the best possible care and maintain a culture of safety.   

    If you have questions about these tips or any other risk management considerations related to COVID-19, contact the ISMIE Risk Management team by email at riskmanagement@ismie.com.

    Where can I learn more?

    More information on reopening your facility or practice:

    Some examples of checklists for reopening include:

    Continue to visit ISMIE’s online COVID-19 resources for more information as the pandemic unfolds.

     

    1 Tawfik DS, Scheid A, Profit J, et al. Evidence relating healthcare provider burnout and quality of care: A systematic review and meta-analysis. Ann Intern Med. 2019 Oct 8; 171(8): 555-567. doi: https://dx.doi.org/10.7326%2FM19-1152.

    2 Berg S. 6 ways to address physician stress during COVID-19 pandemic. American Medical Association.https://www.ama-assn.org/delivering-care/public-health/6-ways-address-physician-stress-during-covid-19-pandemic. Published March 20, 2020. Accessed April 30, 2020.

    The recommendations contained in this resource are not intended to define conduct that is appropriate in every case, should not be considered as establishing any standard of care, and do not constitute legal advice. Physicians, clinicians and healthcare providers should take care to ensure that all care rendered reflects the best clinical judgment and complies with the laws and regulations of the state or location at which the care was provided.