Contributed photo by Erlanger Health System / Christine Gordon, right, gets her temperature scanned by a nurse at the entrance to Erlanger Medical Mall on Friday, May 15, 2020.

As physicians' offices return to providing non-emergency, non-COVID-19-related care, they are implementing new policies and procedures to keep patients and staff safe during the ongoing coronavirus pandemic.

"Basically our process from start to finish has changed," said Dr. Melanie Blake, physician adviser for CHI Memorial. "We're hoping to encourage our patients to resume their attention to preventive care as soon as possible because it will take the rest of this year with aggressive measures to keep everyone caught up on their mammography, on their colon cancer screening, etc., and we're looking forward to resuming relationships with our patients as soon as possible."

For patients who are returning to their doctor's office for the first time since the pandemic began, here are the basics of what you need to know and what you can expect.


Scheduling is strategic

"We're trying to see specific visits at specific times," said Charles Lathram, administrator of Galen Medical Group.

For example, he said, someone complaining of what could be symptoms of COVID-19 would not be scheduled at the same time as a wellness-oriented visit or a visit with a patient in a high-risk population.

Many visits can also be done virtually through Galen's telehealth platform, he said, even annual wellness visits. The patient would only need to come in for blood work or other testing.

To minimize the risk of coronavirus exposure, Memorial's office visits are staggered to prevent a bottleneck as patients wait for lab work or imaging, Blake said. Instead of waiting at the checkout window following an appointment, patients are called to set a followup appointment or referral.

While Erlanger offices schedule appointments in a way that prevents patient queues at the lab and at check-out, patients are still being checked out in the office, said Meridith O'Keefe, senior vice president of Erlanger Medical Group and Physician Services.

"There is still interaction for the well-being of patients," she said. "We have found that when offering so much telemedicine that some patients self-selected out of routine care, so when they are returning for office visits, there is higher acuity of care. Check-out is part of care coordination, so this must occur."


Bring a mask, if you have one

Erlanger requires all patients, caregivers and staff at its practices to wear masks in the office, and patients are required to wear masks when entering Erlanger facilities as well.

"We have masks available if the patient is in need, but would prefer for them to arrive with a mask already on," O'Keefe said.

When patients call a Memorial doctor's office to book an appointment, they are informed of what to expect when they arrive and asked to bring a cloth mask, if they have one, to wear for the duration of their visit, Blake said. Galen Medical Group also requires masks throughout the patient's visit and provides them to patients who need them, Lathram said.


Go alone, if possible

"We're asking that patients who don't need physical assistance come by themselves and not bring visitors or family members with them, unless it's necessary," Lathram said. "We like to keep the number of people congregating in any one area as low as we can."


Waiting room changes

Instead of going to the office's waiting room, Memorial patients are instructed to call the office upon arrival and wait in their cars until they are told to enter. Patients are asked standard screening questions regarding COVID-19 symptoms, and those with symptoms are asked to visit a CHI Memorial Convenient Care clinic rather than a primary care practice, Blake said.

Patients with appointments at Erlanger are called prior to their appointment to be prescreened for symptoms, and upon arrival patients are instructed through external signage to return to their cars and call their doctor's office if they have a fever, cough or respiratory symptoms. Erlanger offices that treat walk-in patients require patients to return to their cars and call the office to be screened for symptoms before entering, O'Keefe said.

Erlanger's shared medical office building spaces, such as the Medical Mall or Erlanger East Physician's Office Building, are screening patients and caregivers through temperature scanning and questions about symptoms before they enter.

Inside Erlanger practices, patients are still using waiting rooms but with enhanced safety protocols. At check-in, all high-touch surfaces such as pens, pad and clipboards are sanitized between patients. Safe seating placards are available throughout the offices that patients and caregivers can place on the seats beside them to separate themselves from other patients, O'Keefe said.


Behind-the-scenes precautions

At Memorial doctors' offices, staff breaks are staggered and nurses' stations are reconfigured to allow more social distancing, Blake said.

All Galen staff members, corporate and clinical, have temperature screenings twice a day, Lathram said. Galen limits the staff going in and out of its "COVID care zones," the separate areas of its facilities where COVID-19 patients are treated. Nurses are also discouraged from congregating in the business offices of its facilities, and staff meetings are held virtually over Zoom rather than in a boardroom.


Patient care is basically the same

Once in an exam room, the patient's visit is conducted in a normal fashion aside from maintaining principles of social distance, more utilization of personal protective equipment and very strict hygiene protocols, Blake said.

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