COVID-19: Three Critical Questions to Address on…

Health systems, particularly in markets with early spikes in COVID-19 cases, have already seen a shift in their ambulatory care demands. There is an influx of visits from patients who suspect they may have the virus, and a decrease in all other visits as patients are unwilling to use health system facilities for fear of infection or a desire to minimize their interactions in the community. The shift in ambulatory care demand begs three questions for ambulatory care leadership:

How do we best support the needs of our current patients and others seeking triage, testing and treatment? [Immediate / 0-3 months]
How will we accommodate the influx of patients who do not have COVID-19 and are currently delaying or deferring care? [Short-term / 3-6 months]
How can we expand our ambulatory network and capabilities to accommodate both future spikes in demand and support ongoing patient access and care delivery? [Long-term / 6+ months]

Immediate Need: How do we best support the needs of our current patients and others seeking triage, testing and treatment?

Consider the following to respond to the current COVID-19 crisis:

Triage patients with suspected COVID-19 based on symptoms and risk factors: Consider ramping up the availability of triage and support — via nurse triage lines, online portal support from clinic staff and chat-bots — to triage patients to the appropriate level of care and provide consistent communication to patients who fear they may have contracted the virus.

Cohort COVID-19 patients within existing sites for testing and treatment: Cohort patients within clinics by creating separate waiting rooms for “sick” and “well” patients, directing patients to use specific hallways and exam rooms based on their visit type, and appointing patients during the day so sick and healthy patients are not coming in at the same time (i.e., sick visits come in the morning and healthy visits come in the afternoon).

Create centralized testing services outside of the traditional sites of care: Health systems with significant current or anticipated volume can set up remote clinics to support testing and treatment. Explore opportunities to do this in partnership with other health systems in the market at a centralized site. Establish procedures, processes and locations for ambulatory COVID-19 testing including options for drive-through, walk-in or alternative site testing.

Transition select patient populations to different appointment dates, sites of care or providers: The health system, particularly primary care clinics, may need to postpone seeing “well” visits and may need to identify new channels and providers to support patients with stable chronic conditions (postponing treatment for these patients puts them at risk of deteriorating, however, these patients may safely be seen less often and/or monitored remotely during high-demand periods). The intervention will differ by patient population (e.g., postpone “Medicare Wellness Visits,” have diabetic nurse educators follow up with diabetic patients via the phone, enable pharmacist to independently see polypharmacy patients).
Consider options for redeploying workforce to high-demand areas: Anticipate workforce needs to redeploy providers and staff into high-need areas, such as redeploying resources into virtual modalities to increase virtual visit capacity, triage functions, testing sites and clinics experiencing high volumes of potentially sick patients. Identify a small team to act as the coordination of the all-hands-on-deck workforce management to make quick decisions regarding deployment.
Encourage patients to stay home or transition back to home when possible: If a patient has a suspected virus, encourage them to stay home and monitor their condition. Health systems that have a more advanced digital health footprint may be able to support remote monitoring with devices that connect directly into the EHR (e.g., pulse oximeters that automatically transmit data to the care team).
Expect and plan for materials and pharmaceutical shortages: We can anticipate there will be rolling shortages of essential materials and pharmaceuticals as the supply chain will be both disrupted and overtaxed. Plan now by creating rapid decision-making structures for policy and protocol changes.
Communicate with patients and community: Provide proactive and ongoing communication with patients and the broader community to provide clear guidance on how, when and where to get testing and care. The communication should be consistent across all staff speaking with patients at the call center, within various clinics and across all modalities (e.g., patient portal, mobile app and website). Consider enabling telephonic communication by adding new branches to the phone tree that permit patients to quickly connect to someone who is well-versed in responding to questions related to COVID-19.

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Short-term: How will we accommodate the influx of patients who do not have COVID-19 and are currently delaying or deferring care?

Ambulatory visit volume may dip during the height of the COVID-19 crisis from patients who opt to stay at home for fear of infection and peak as the virus dissipates. The following tactics can be deployed in anticipation of the influx of visits as COVID-19 illness declines:

Increase availability: Increasing the availability of provider, imaging and exam slots on a time-limited basis may be required to accommodate the influx of post-pandemic demand and prevent the development of a long wait for care. Strategies for this time-limited period may include expanding hours during the week and providing weekend hours. Ensure providers have enough support and resources to effectively see and treat patients during these expanded hours by aligning staff and provider schedules.

Empower non-physician providers to manage stable, chronic illness patients: Explore opportunities to have non-physician providers (e.g., advanced practitioners, home health nurses, pharmacists) connect with and manage appropriate patients via phone, patient portal and home visits. Define the patient population and interventions by provider type, and create systems to support the interventions (e.g., EHR templates, decision trees).

COVID-19: Three Critical Questions to Address on Ambulatory Care

Immediate Need: How do we best support the needs of our current patients and others seeking triage, testing and treatment?

Short-term: How will we accommodate the influx of patients who do not have COVID-19 and are currently delaying or deferring care?

Long-term: How can we expand our ambulatory network and capabilities to accommodate both future spikes in demand and support ongoing patient access and care delivery?