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Executive Session: “There is no room for error” in keeping medical workers safe amid COVID-19

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Jason Persoff, MD, associate professor of medicine and assistant director of emergency preparedness at the University of Colorado Hospital in Aurora, Colo., says he has found that being in an actual disaster to be incredibly educational.

In 2011, Persoff — who had a background as an EMT in college and has been a storm chaser for decades — saw how crucial the work of healthcare providers can be in an emergency when an EF5-rated tornado that struck Joplin, Mo., late in the afternoon of May 22, 2011. That tornado killed 158 people and devastated the local hospital and countless other healthcare facilities.

While he saw 50 patients that night, Persoff notes that there was a sizable gap in emergency preparedness at different levels of the organization. “The bosses and everyone above knew exactly what was going on with how to manage the disaster, and they did a fantastic job,” Persoff said. “But the people who were actually taking care of the patients … they didn’t know the best way to respond in these disasters.”

Persoff eventually decided to shift toward internal medicine but did not give up his focus on emergency preparedness in medical settings.

David N. Gans, MSHA, FACMPE, senior fellow for industry affairs, MGMA, noted that in addition to his time at MGMA, he had a parallel career in the U.S. Army Reserve, retiring as a colonel in the Medical Service Corps after years of working to train professional support staff on how to care for patients in various environments, including battlefield trauma situations and bioterrorism.

“Most of our training was not identifying or treating disease,” Gans noted, “but how to protect our doctors, nurse and support staff so they would not become casualties themselves. The same situation applies today for medical practices on the front line of treating patients who may be infected with COVID-19.”

With the probability that most primary care practices and many specialty groups will be confronted with patients infected by the 2019 coronavirus, it’s imperative to understand how the virus spreads and what practice leaders can do to minimize the chance that their providers or staff will become infected, Gans added.

Educating and encouraging social distancing

One of the first steps to protecting your healthcare providers and staff, Persoff noted, is to better educate patients about the disease and help them do more to limit their exposure and minimize the potential spread of the illness. “The single most important thing is that patients needs to practice social distancing,” Persoff said, noting that individuals should avoid crowds and maintain a distance of six feet from others. The temptation to visit someone who may be ill might be strong for some, but “at this point in time, it’s very important to avoid anybody who may be ill in order to minimize your risk.”

“The best way a pandemic can play out is if we use a lot of social distancing,” Persoff said. “If we can slow down the spread of the disease, so it's sustained over a longer period of time, that actually is better.”

When people don’t practice social distancing, it sets the stage for getting more people sick in a short span of time. A scenario with less social distancing and a broader spread of COVID-19 all at once would “rapidly outstrip” the capabilities of the nation’s healthcare facilities.

The use of masks and other protective personal equipment (PPE) is also very important, as well as hand-washing. “The single most important thing that reduces the risk is washing your hands,” Persoff said, who added that is does matter how long you do it (20 seconds is recommended to break down the virus), and to not touch anything you don’t have to once you’ve finished washing.


Additionally, Persoff encouraged practices to consider how best to push more patient visits to telehealth rather than in-person visits. “Instead of face-to-face time with a patient, we can just go to FaceTime with patients,” Persoff said. “By reducing the number of patients that come into your practice, you really are reducing the risk of patients having potential to seed illness in your staff.”

Whenever a patient does come to the practice and is suspected of COVID019, managing how that patient leaves the facility is also important, Persoff said. “How are you going to disinfect the area? What is going to be your protocol?” Persoff said that signage and posters can be helpful in reminding providers and staff of changes in protocol and patient flow. If a primary care practice needs to send a patient for hospitalization, “not only do you need to place a mask on them, but you need to call ahead to the emergency room to let them know what’s going on,” Persoff said, adding that it’s also important to notify your local health department for a patient that screens positive for COVID-19, so that patient can be followed over time and case tracing can be performed.

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The threat to healthcare workers

Persoff noted that one of the more important distinguishing factors between the past SARS epidemic — which had a significant infection rate in healthcare facilities, including doctors and nurses — and the current COVI-19 pandemic is that there weren’t proper precautions for dealing with aerosolized particles during the SARS response.

At the time, “there wasn’t a lot of emphasis on face shields … high-particulate-filtering masks, such as N95 masks,” Persoff said. “And the consequence of that was these particles became aerosolized, people very easily came in contact with particles around their face and were able to get the disease fairly easily. With COVID-19, there’s been a real mindful approach about this.”

Beyond ensuring the proper PPE is available and that providers and staff are educated on donning and removing those items, Persoff added that it’s important to understand what your limitations might be if practicing in a small office.

If a patient comes in and needs to be isolated, “it is important to have a room where you can place these patients … and try to limit their contact” with certain equipment, such as blood pressure machines and pulse oximeters. Persoff also noted that areas where a patient is suspected of COVID-19 should sit undisturbed for one hour before cleaning it down. “There’s no room for errors,” Persoff cautioned. It’s very common, especially in emergency rooms, to see everyone playing fast and loose with PPE, but really there’s no room for that in this particular setting.”

Know your message

As healthcare providers, clinics and other facilities have a crucial role to play in amplifying guidance for patients and the general public about how to stay safe, which has the downstream effect of helping to keep your practice staff safer. “The CDC is your friend, and they have an incredible amount of links to really get at questions you may have,” Persoff said.

Understanding that guidance and finding the right ways to communicate those messages to patients can be a valuable asset in the response to COVID-19. “There’s lots of ways you can get creative to get patients engaged in their care,” Persoff added, noting that updating a practice website with information is a good step. “The most important thing is to stay fact-based.”

And above all else, Persoff said that everyone — working in healthcare or otherwise — can do one thing above all else: be kind. “Don’t be selfish,” Persoff said. “Don’t buy things — such as toilet paper — for diseases we don’t have right now, and try to be mindful of how you can be helpful to everyone else.”
 

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