Back to Wellness: Rebuilding while managing through COVID-19.

What will “back to wellness” mean in the weeks and months ahead? Clinical and supply chain experts agree that recovering from the coronavirus will demand strong leadership from physician-owners, managers and health system administrators, and expert guidance from infection preventionists, laboratory professionals and supply chain executives. In June, Journal of Healthcare Contracting Publisher Scott Adams anchored a “Back to Wellness” podcast series on the topic, sponsored by McKesson Medical-Surgical.

For physicians and facility managers, communication with staff prior to reopening will be critical, said Dr. Luis Rios Jr., MD, FACS [Rios Center for Plastic Surgery]. Staff who have been furloughed will need to review preexisting protocols and learn new ones, he said. Practices should try some dry runs with a few patients before opening their doors to all. “Don’t open the floodgates all at once,” he said.

Triaging patients will be part of the “new normal” for physicians and surgery centers, said J. Hudson Garrett Jr., president and CEO, Community Health Associates LLC, in Atlanta, and assistant professor of medicine, Division of Infectious Diseases, University of Louisville School of Medicine. Some practices and surgery centers might require patients to self-quarantine for a few days prior to their procedure or appointment (though, admittedly, that will be difficult for patients who need to work and cannot do so remotely.) Screening for illness, fever or COVID-19 symptoms will be common.

“But too often, the screening I see is simply, ‘Have you had symptoms? Do you have a fever?’” said Garrett. Providers also need to find out if the patient has traveled recently, or if they have been exposed to someone with a serious illness, such as COVID-19.

Physician practices will need to prepare for walk-ins, said Marc-Oliver Wright, MT (ASCP), MS, CIC, FAPIC, clinical science liaison, PDI Healthcare. They should post visuals to instruct patients what to do upon entering the facility, such as donning a mask, performing hand hygiene, etc. “You’ll need good physical separation in waiting rooms, or prompt rooming on arrival,” he added. Respiratory etiquette stations will be necessary.

Physician owners, administrators and clinical directors will also have to recognize the emotional needs of their staff. “Feeling safe on the part of staff is one of the most important things for managers to keep in mind,” said Crissy Benze, MSN, BSN, RN, Progressive Surgical Solutions, a division of BSM Consulting. Someone in the facility must be charged with monitoring updates from local, state and federal governments, stocking adequate supplies of personal protective equipment, ensuring that infection prevention protocols are adhered to, and keeping the staff informed of changes.

“In my career as an infection preventionist, one thing I’ve learned is that you cannot communicate with your staff enough in times like these,” said Wright. “We tend to think that everyone in healthcare is equally well-informed, but that’s far from the truth.

“Hyper-communicating is probably the best thing for the practice. Lack of it breeds anxiety and fear. Staff will find information on their own, but not all of it is created equal. There’s information that is reliable and evidence-based, such as what you get from CDC or state and public health agencies … and then there’s everything else. So it’s really important to have that dialogue.”

Infection prevention

One silver lining: COVID-19 has brought to the public’s attention the importance of infection prevention. But the road ahead for infection preventionists will be challenging.

“We keep talking about returning to a ‘new normal,’ but at the same time, we don’t know exactly what that means,” said Wright. “COVID-19 is new, unlike anything we’ve seen before,” including the 1918 pandemic. “Infection preventionists are being challenged to be proactive, responsive and pragmatic.” They may face new obstacles, including product shortages.

Your med/surg distributor can help providers stay on top of the situation, said Steven Dunn, senior segment manager for ASCs and Orthopedics. For example, we have introduced a “PPE estimator” as part of the McKesson Business Analytics (MBA) tool. Based on guidelines from the Centers for Disease Control and Prevention and other authorities, the tool helps providers to estimate how much PPE they will need in order to meet future demand, based on their estimates of patient volume and characteristics.

“This is a time to develop alternative plans or conservation plans,” added Wright. Some providers have started reusing and reprocessing what historically had been single use items, such as N95 respirators. “They’ve done this out of necessity; but as we continue, white papers and recommendations will be published so others can learn from them.”

The lab

Just as COVID-19 underscored to the public the need for sound infection prevention, so too has it demonstrated the significance of point-of-care testing.

“We have always believed that having the highest-quality testing as close to the patient as possible helps ensure that providers accurately diagnose, treat and care for patients locally,” said Derek Young, vice president, advanced product sales, McKesson Medical-Surgical. “COVID-19 hasn’t changed the way we feel about POC testing, but it has really driven home the point nationwide. We are finding that many providers who had chosen not to have laboratories or to have only limited ones are rethinking their strategies.”

COVID-19 brought with it shortages of lab instruments, tests, supplies and PPE, as well as a plethora of unreliable tests on the market, added Young. “We heard horror stories about the impact of poor-quality testing or the misuse of tests, such as using antibody tests to diagnose active infections,” he said. The situation will become more complex come flu season. Physician practices will need to develop a plan, especially around respiratory illnesses.

That plan will drive what providers need from a testing standpoint, and it should prompt them to begin the implementation of that strategy as early as possible, said Young. “I’m afraid that those who wait until October or November may find themselves at the back of a very long line,” he said. Given suppliers’ inventory and manufacturing challenges, providers should consider bringing in redundant testing systems, including test kits and analyzers.

“We’re already preparing for COVID 2.0 this fall,” said Greg Colizzi, vice president, marketing, Health Systems, McKesson Medical-Surgical. “If that occurs, it will overlap with flu and pneumonia season. Providers will need vaccines and pharmaceuticals for treating symptoms, and a lab strategy not only for COVID-19, but for flu screening and testing.”

Caring for patients who have been discharged from a hospital for COVID-19 treatment will present its own set of challenges, he said. Many patients recovering from COVID-19 treatment have underlying health conditions that can become more severe, including heart disease, kidney disease and pneumonia. Providers may also see more patients with depression and cognitive impairment. “They will need to carefully think through patient requirements and the protocols and equipment needed to treat them, including home monitoring,” Colizzi said.

Despite all its challenges, COVID-19 may advance the healthcare industry and profession, said Garrett. “People now recognize that public health is instrumental in stopping epidemics,” he said. “We have seen unparalleled collaboration between the public and private sectors, and the resilience of the American people. And we can get back to work with good infection control practices in place. The challenge will be, ‘Can we sustain all these positives?’”

To listen to the full podcast, as well as the other podcasts in the “Back to Wellness” series, visit www.jhconline.com/back-to-wellness-podcast-series.html.

Whether you never stopped working, are now seeing patients virtually, or are working through your re-opening process, McKesson’s main focus is finding ways to make the products you need available so that you can do what you do best.

Visit McKesson’s COVID-19 webpage regularly for updates, recommendations, best practices, webinars and resources.

Questions on providers’ minds

Your health system’s physician practices and ambulatory surgery centers have plenty to think about as they reopen their doors. Participants in the “Back to Wellness” podcasts mentioned a few:

  • How will we screen/triage our patients?
  • How will we accommodate patients who are suspected of having COVID-19?
  • How will we accommodate social distancing in the office?
  • What is our protocol should a staff member contract the virus?
  • Who on staff will serve as our COVID-19 “point person,” staying abreast of developments in disease incidence, vaccinations and treatments?
  • What kinds of PPE will we need? How much will we need?
  • Who will train staff to use PPE properly – not too little, but not too much either?
  • What should be our protocol for cleaning and disinfecting exam rooms, treatment areas and common areas?
  • How can we use point-of-care testing to guide treatment decisions?
  • What kind of respiratory illnesses can we expect to see in the coming 2020-2021 influenza season?
  • What will the “new normal” look like after COVID-19?