Healthcare Providers

LHC Reopening Procedures: Stage One (DURATION: TBD, PROJECTED TO BE A FEW WEEKS)

30APR2020

Purpose: Provide clear guidance for reopening of clinics and required underlying activities during Stage One of reopening.
Structure: Procedures are organized into three groups: (1) Points of Entry, (2) Transmission, and (3) Sustainment.

Points of Entry
Intent: Secure clinics from viral entry – maintain exterior walls as barriers against the spread of COVID-19.

Patient Screening | At the time of a patient’s arrival to the clinic, they will go through two screening gates. First, a list of symptoms which will disqualify the patient from entry will be posted on the exterior door to the clinic. If a patient does not present with any of these symptoms, they will proceed into the waiting room, where their temperature will be taken using a non-contact thermometer. Patients with temperatures above 100.3 will be directed to immediately exit the clinic and to see their primary care physician for COVID-19 screening prior to returning for therapy. All screening will be documented.

Staff Screening | At the time of a staff member’s arrival, they will go through the same two screening gates as patients.

Reduced Staff | All non-essential staff members (e.g., headquarters staff) will continue to telework, eliminating them from potentially carrying a pathogen into clinic environment. Sales & Marketing personnel will be restricted from entering clinics as well – any communications will be digital or contactless, ensuring compliance with HIPAA and associated regulations

Non-Patient Visitors | No patient visitors will be permitted to enter the clinic. All family members, guests, pets, etc., must remain outside the clinic. Patients requiring direct assistance from a family member will be deferred to Stage Two.

Deliveries | Delivery personnel (mail, package, etc.) will be required to undergo patient/staff screening gates (see above).

Hand Sanitizer | Before and after entering the clinic from the waiting room, patients/staff will use provided hand sanitizer.

Admin Window | At all times, except during the checking of temperature, the admin window will remain closed.

Staff Conduct | Staff members will continue to shelter in place while not in the clinics and will wear protective face coverings (masks) in the presence of individuals not sheltering in place with them (at stores, family gatherings, etc.). Staff will also certify that individuals sheltering in place with them are taking acceptable precautionary measures to mitigate viral transmission at their respective places of business. Finally, staff with additional jobs will undergo additional precautionary screening to ensure precautionary measures at additional job meet Legacy approval.

Non-Therapy Visits | No in-person orientations will be conducted. Orientation and MD Visit will be exclusively telehealth.

Patient Materials | Patients will not be permitted to bring additional materials (blankets, books, etc.) into the clinic. Materials inviting multiple touches (magazines, candy jars, etc.) will be removed from the clinic during Stage One.

Patient Transportation | No patient transportation is allowable or available during Stage One

Transmission
Intent: Prevent potential methods of transmission.

Masking | All personnel in the clinic will cover their nose and mouth at all times using a procedure mask to be provided by Legacy. Staff masks will be utilized on a daily basis and disposed of at end of day. Patient masks will be utilized on a weekly basis and will be stored in Ziploc bags, which will be provided to the patient by Legacy. Upon exiting the clinic, the patient will exit the waiting room, place their mask in their Ziploc bag, seal it, and then exit the building. Upon returning, the patient will open the Ziploc bag, put on the mask, and then enter the waiting room. The patient will be responsible for maintaining positive control of their mask during the time when they are not at the clinic. Patient masks will be issued on a single-patient basis by hanging a mask on a freshly sanitized doorknob in no more than two minutes in advance of the patient’s first arrival.

Headphone Covers | Ear cups on headphones will be swabbed with alcohol pads immediately before patient use.

Patient Distancing | Patients will be spaced out throughout the day to minimize patients in the clinic at any given time, in accordance with state guidance. Patients will be placed on treatment beds at a maximum distance from one another.

Staff Distancing | Staff will remain a minimum of six feet from patients and other staff members at all times, except during the application of therapy-related materials (cuffs, leads, etc.) or during therapy timing.

Restrooms | Restrooms will be available to patients and staff. Ventilation fans will remain on during all business hours, and high-touch areas in restrooms will be cleaned and sanitized after each use, using disinfectant spray and/or single-use wipes.

Hand Sanitizer | Before and after entering the clinic from the waiting room, patients/staff will use provided hand sanitizer.

Admin Window | At all times, except during the checking of temperature, the admin window will remain closed.

Staff Conduct | Staff members will continue to shelter in place while not in the clinics and will wear protective face coverings (masks) in the presence of individuals not sheltering in place with them (at stores, family gatherings, etc.). Staff will also certify that individuals sheltering in place with them are taking acceptable precautionary measures to mitigate viral transmission at their respective places of business. Finally, staff with additional jobs will undergo additional precautionary screening to ensure precautionary measures at additional job meet Legacy approval.

Changing Rooms | Changing rooms will be closed. Patients should wear their treatment pants to their appointment. Patients should feel welcome to wear other garments over their treatment pants, should they desire to do so, for their travel, and may remove extra garments in the restroom or next to their treatment unit.

Arrival Process | When patients arrive at the clinic, they will remain in their vehicle and call the clinic phone number. The admin will check the schedule, verify that they have arrived at a time which fits their scheduled time, and then invite them to come into the clinic. If the patient is early, they will be asked to remain in their vehicle until their scheduled time. If the patient is late, they may be accommodated immediately, or may be asked to delay until an appointment is available to maintain appropriate distancing.

Patient Contact & Examination | All patient contact for medical examination will be conducted with gloves on, and hands will be sanitized both before and after any contact. No spirometry exams will be conducted until further notice.

Cleaning & Sanitization | Technicians will thoroughly clean all surfaces touched by a patient with disinfectant spray. This includes, but is not limited to, the treatment bed, cuffs, hoses, pulse oximeters, headphones (even while covers are utilized), railings, counters, and doorknobs. This cleaning will occur immediately after contact, or as soon as is practicable thereafter. Moreover, high-touch areas (keyboards, mice, doorknobs (including waiting room exterior doorknob), counters, cabinet handles, drawer pulls, phones, light switches, etc.) will be cleaned and disinfected hourly by the admin.

Linens & Laundry | Patient linens (pillowcases) will be changed for each patient. Linens will be collected in a central collection point, and hands sanitized after touching that collection point (during the changing process). Linens will be washed, using hot water and chlorine bleach, daily. Cuffs will be disinfected using disinfectant spray after each use and washed if soiled.

Sustainment
Intent: Ensure long-term viability and backup options for procedures.

Staff Platooning | Where possible, staff will be divided into two groups and scheduled accordingly. These groups can be scheduled AM/PM or alternate days at the clinical director’s discretion and depending upon the individual constraints of the workforce. By platooning the workforce, any exposure can be quarantined to the exposed staff, allowing clinic continuity.

Reopening Expansion | Leaders will meet Monday-Wednesday-Friday by videoconference to review reopening status, governmental guidance, and recent news in order to validate or adjust reopening procedures.

Exposure Quarantine | In the event of a documented exposure to COVID-19, clinic contact tracing can be undertaken using schedules and documented points of interaction. Should this occur, local quarantine guidelines will dictate response.

Ensuring Patient Census | Patients will be called by clinical directors to address return to therapy. Patients will be advised of precautionary measures, screening criteria, process changes, and scheduling requirements, and will subsequently be scheduled for therapy. Calls will be made 24 hours in advance of treatments to confirm the patient’s intent to attend.

Patient Deferral | Patients in governmentally identified elevated risk categories and those needing transportation or family member assistance will be deferred for treatment at a later date, properly shielding them from potential risks and ensuring that they are healthy to treat in the future.

Inventory | A daily inventory report will be provided by clinic staff at the end of each day of operation. This inventory report will include the quantity of sensitive items (PPE and cleaning supplies) present at the start of the day, the number used in therapy, and the count at the end of the day. Orders will be placed proactively to minimize interruptions in the supply chain.

Messaging | Patient calls will be made first by clinical directors. Subsequent calls will be made by admins. Signage will be placed in each clinic explaining protocols and clearly explaining relevant steps. Staff will be provided an FAQ document regarding basic answers to expected questions. Escalations will be direct to President.

Reopening Procedures: Stage One Appendices

28APR2020

Purpose: Provide support to procedures outlined in Reopening Procedures: Stage One document. Structure: Appendices are numbered (1, 2, 3) and titled to reflect the Procedure group and topic they support.

Appendix 1 – Patient Screening, Staff Screening, & Deliveries

Have you been exposed to COVID-19 or knowingly exposed to anyone who has been knowingly exposed to COVID-19?

Have you experienced any of the following symptoms: Cough, Shortness of Breath, Difficulty Breathing, Chills, Repeated Shaking with Chills, Muscle Pain, Headache, Sore Throat, Loss of Taste or Smell, Diarrhea?

Have you traveled in the last twenty-one (21) days via airplane?

Appendix 2 – Reduced Staff

Staff allowed to enter clinic: Clinical Director, Associate Clinical Director, EECP Flow Therapy Technician, Clinical Administrator

Staff excluded from clinic: All Others, unless covering a shift for a role listed above

Appendix 3 – Patient Distancing

Available Treatment Windows are listed below. Treatment Windows reflect the time the patient should be placed on the bed, so patients are permitted to enter the clinic seven minutes prior to Treatment Window.

AVAILABLE TREATMENT WINDOWS (all times local, all facilities except Fort Worth)
Entry Start Finish Exit Entry Start Finish Exit
6:53 AM 7:00 AM 8:00 AM 8:07 AM 11:33 AM 11:40 AM 12:40 PM 12:47 PM
7:23 AM 7:30 AM 8:30 AM 8:37 AM 12:03 PM 12:10 PM 1:10 PM 1:17 PM
8:03 AM 8:10 AM 9:10 AM 9:17 AM 12:43 PM 12:50 PM 1:50 PM 1:57 PM
8:33 AM 8:40 AM 9:40 AM 9:47 AM 1:13 PM 1:20 PM 2:20 PM 2:27 PM
9:13 AM 9:20 AM 10:20 AM 10:27 AM 1:53 PM 2:00 PM 3:00 PM 3:07 PM
9:43 AM 9:50 AM 10:50 PM 10:57 AM 2:23 PM 3:30 PM 3:30 PM 3:37 PM
10:23 AM 10:30 AM 11:30 AM 11:37 AM 3:03 PM 3:10 PM 4:10 PM 4:17 PM
10:53 AM 11:00 AM 12 Noon 12:07 PM 3:33 PM 3:40 PM 4:40 PM 4:47 PM
AVAILABLE TREATMENT WINDOWS (all times local, Fort Worth facility)
Entry Start Finish Exit Entry Start Finish Exit
6:53 AM 7:00 AM 8:00 AM 8:07 AM 11:33 AM 11:40 AM 12:40 PM 12:47 PM
7:13 AM 7:20 AM 8:20 AM 8:27 AM 11:53 AM 12 Noon 1:00 PM 1:07 PM
7:33 AM 7:40 AM 8:40 AM 8:47 AM 12:13 PM 12:20 PM 1:20 PM 1:27 PM
8:03 AM 8:10 AM 9:10 AM 9:17 AM 12:43 PM 12:50 PM 1:50 PM 1:57 PM
8:23 AM 8:30 AM 9:30 AM 9:37 AM 1:03 PM 1:10 PM 2:10 PM 2:17 PM
8:43 AM 8:50 AM 9:50 AM 9:57 AM 1:23 PM 1:30 PM 2:30 PM 2:37 PM
9:13 AM 9:20 AM 10:20 AM 10:27 AM 1:53 PM 2:00 PM 3:00 PM 3:07 PM
9:33 AM 9:40 AM 10:40 AM 10:47 AM 2:13 PM 2:20 PM 3:20 PM 3:27 PM
9:53 AM 10:00 AM 11:00 AM 11:07 AM 2:33 PM 2:40 PM 3:40 PM 3:47 PM
10:23 AM 10:30 AM 11:30 AM 11:37 AM 3:03 PM 3:10 PM 4:10 PM 4:17 PM
10:53 AM 11:00 AM 12 Noon 12:07 PM 3:33 PM 3:40 PM 4:40 PM 4:47 PM
10:43 AM 10:50 AM 12 Noon 11:57 AM 3:23 PM 3:30 PM 4:30 PM 4:37 PM
11:03 AM 11:10 AM 12:10 PM 12:17 PM 3:43 PM 3:50 PM 4:50 PM 4:57 PM
Appendix 4 – Messaging

Selected signs are shown below.

These two signs will be hung on the outside of the clinic door:

It’s Great to be Back.

As an Essential Service helping to reduce hospitalizations and lessen the burden on our colleagues in the medical community, we’re proud to be back open, helping you to treat your heart disease with confidence. Please join us in taking the necessary precautionary measures to ensure that this continues to be the case

Call Us To Check In

If you haven’t already called us to check in, please do so before entering. Our phone number is 123-456-7890.

Symptoms Check

Please review our Symptoms Screener to the right of this sign, and if you have any of the items listed, please contact our Clinical Director before entering.

Don Your Mask

Please remove your mask from its Ziploc bag and don it, ensuring you fully cover your nose and mouth.

Temperature Check

Come on in – our admin will check your temperature, and we’re excited to get you back for therapy!

Symptoms Screener

Do any of these apply to you? If so, please contact our Clinical Director by phone at 123-456-7890 before entering the clinic.

Positive Test or exposure to COVID-19?

Short of breath?

Had a cough?

Traveled in the last 21 days by airplane?

Sore Throat?

Chills?

Fever?

Muscle Pain?

Headache?

Difficulty Breathing?

Loss of Taste or Smell?

Diarrhea?