Reactivate: 3 ways to address your facilities as you see more patients

After months of limited operations and heightened pressure, many healthcare providers have been reinstating or reinvigorate elective service while managing fluctuations in COVID-19 patients.

Hospitals, health systems, ambulatory care networks, physician practices, and other providers are eager to see additional patients and restore financial performance.

The American Hospital Association estimates that total projected losses to hospitals and health systems in 2020 to at least $323.1 billion. This is due to adding COVID-19 critical patients as well as the loss of elective services. Though they are largely insulated from the acute-care handled by hospital systems, ambulatory care networks and physician practices have also incurred dramatic losses from suspended standard procedures and, in some cases, overflow COVID-19 care.

The following considerations will not only help healthcare organizations prepare facilities for safer operations, but also introduce methods to help strengthen their future.

(re)invigorate facilities

Unlike a typical business, healthcare providers already have expertise in infection control and patient safety. However, you will need to augment your standard infectious disease protocols with new COVID-19 risk mitigation practices as you rebuild your elective care volume. As a growing number of patients begin to enter and occupy your facilities, you’ll need to anticipate and manage every step of their progression through your lobbies, hallways, patient rooms and treatment areas. The following are considerations for creating a safe facility experience for employees, patients and visitors alike.

1. Assemble the right team to design and disseminate a facilities management plan for elective services.

Preparing your facilities to care for non-COVID-19 patients will require a coordinated effort. With a team comprising facilities, infection control and clinical staff, as well as your patient privacy officer and possibly human resources (HR), you’ll be better equipped to address all dimensions of non-emergency care—including regulatory compliance—to mitigate the risk of COVID-19 infections occurring during elective procedures. Your frontline staff will want to know how you are reducing risk and will undoubtedly have many practical ideas to contribute. And, the right mix of team members will help you balance safety and wellness ideals against achievable outcomes.

2. Create a plan to ensure the health and safety of your patients and visitors—and publicize.

Before you increase your volume of non-emergency care, you must develop new standard operating procedures (SOPs) and playbooks to ensure the safety of patients and visitors in your facilities. And, if your organization operates a medical office building or ambulatory care network, consider exporting hospital-grade infection control standards to these lower-acuity settings.

While every facility will have different needs, these new practices will encompass a myriad of issues beyond social distancing, including greater use of PPE, additional cleaning and disinfecting protocols and visitor screening protocols. For each facility, you’ll need a plan for managing waiting rooms, overflows of inpatient procedure patients, elective procedures, COVID-19 versus non-COVID-19 patients and discharge procedures. Proactive information and guidance for patients and visitors will be essential in soothing their concerns of exposure in a treatment setting, as these fears run deep within a large segment of the population. Concise, consistent, and reassuring communication is key to assuaging these fears. 

3.Take infection control to a new level 

In addition to your traditional SOPs for cleaning and disinfection, additional measures will be needed to further reduce COVID-19 risks. One simple step, for instance, is to remove items such as plants, magazines, non-essential displays or excess furniture throughout your facilities to streamline cleaning and reduce the plethora of potentially infected surfaces. Where possible, utilize non-porous, easy-to-wipe surfaces (floors, wall coverings, furniture and screens) that can be thoroughly cleaned.

The following are additional emerging strategies for preparing and managing your facilities as non-emergency procedures are reinstated.

Public spaces.
Thoughtful management of patient and visitor paths of travel will be critical for maintaining social distancing within your facilities.

To completely segregate patients and caregivers from patients displaying COVID-19 symptoms, the Centers for Medicare and Medicaid Services (CMS) has advised that organizations create non-COVID care (NCC) zones. A zone could be a separate building, designated rooms, or a separate floor or entrance, with minimum crossover with COVID-19 patient intake and treatment areas. Anyone entering the NCC—whether caregivers, housekeeping, patients or others—is screened via temperature check. 

Another solution is to manage patients by type of need or condition. A mother in labor, for instance, often would enter a hospital via the emergency room (ER). Since patients with COVID-19 symptoms also tend to arrive through the ER, a new SOP would direct non-COVID-19 patients to use the hospital main entrance.

For any patient or visitor arriving at your main entrance and registration desk, you’ll need to manage their pathways to and from the desk to their next destination. Using floor markers, rope barriers, signage or other means to enforce social distancing, you can direct the patient (and companion) to follow one-way directional indicators to and from the relevant treatment area. 

Waiting rooms.
You’ll need a strategy for managing waiting patients and patient overflow for elective procedures. Some healthcare providers have simply closed their waiting rooms, requiring patients to wait in their cars. An alternative solution is to use floor marketers or rope barriers to indicate safe distances and paths of travel. Additionally, remove chairs to limit room capacity. Space planning and utilization metrics for exam rooms and other spaces is a valuable way of assessing capacity limits and minimizing patient overflow.

Inpatient and exam rooms.
Patients will be reassured by visibly available hand sanitizers and wipes in their rooms, and by seeing that all employees—beyond clinical staff—are wearing masks. You’ll need stepped-up protocols for cleaning and disinfecting patient, treatment and exam rooms in between patients, in coordination with clinical and housekeeping staff. Ensure each patient has one companion in their room at a maximum. Create rotational schedules for clinicians and facilities staff. Ensure minimal furniture and equipment, provide floor markers to show where clinicians, companions and staff should stand.

For detailed checklists, best practices, floorplans, and other creative tools to succeed in the current and post-COVID-19 era, download the Reactivate Guide here

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