In-Office Flow

To consider:

• After-hours clinic: what is expected, how to manage, consider an answering service to allow patients to be distanced appropriately if brought into office.
• AHCs: Consider doing your AHC virtually with the option of bringing patients into the office if a virtual visit suggests that a physical exam is required.
• Allergy shots: how will you manage these safely, allowing time within the office post-injection where patient is physically distanced from others?
• Equipment turnover: need dedicated equipment for COVID-suspect patients
• Staffing: how many staff do you need in the office?

Physical Office set-up

General

• If safe/private to do so, leave doors open to avoid repeated door knob contact.
• “Common areas” used by multiple physicians/staff – i.e. lab, storage rooms, procedure rooms, weigh scales, etc.
  • Limiting the number of different individuals that use these areas (i.e., dedicated staff for lab?)
  • Disinfecting these areas, etc.
• Keep rooms “bare” – keep surfaces clear of equipment other than computer monitor
• More general tips in this OCFP document

Exam Rooms

• Keep rooms “bare” – keep surfaces clear of equipment other than computer monitor
• Anticipate what you will need for the visit and bring into exam room with you (i.e., tongue depressors, reflex hammers, swabs, etc.)

Reception Area

• Plexiglass barrier: contact installers in your local area
• Health cards: don’t take health cards. Validate online or visual check of version code without handling card
• Install visual cues to maintain physical distancing – until we receive more direct advice for health care offices, here are some ideas from the business sector:
  • Resource: https://www.ideas42.org/blog/designing-for-effective-physical-distancing-in-essential-public-spaces/
    • Make all aisles one-way with clear waymarks on the ground noting the flow of traffic, and use street traffic signs (do not enter, yield, one-way) to facilitate, as they’re already familiar to people in other contexts
    • Tape simple guides on the floor throughout the office to help people space by at least six feet throughout their time in the office.
    • By reception, create physical cues on the floor and at the reception window to tell patients to wait six feet from the window until it’s their turn.
    • Place or paint a picture of feet near where you want patients to be/stand while they’re waiting for reception/ other staff.
  • Resource: https://planet-lean.com/spaghetti-chart-physical-distancing/

Waiting Room

• Chairs: space chairs by 2 metres, consider vinyl/plastic for wiping
• Remove toys, magazines, remote controls, etc.
• Provide visual cues to maintain social distancing (to come)
• Have available: tissues, alcohol-based hand rub and a waste basket

Reducing time in office

• Pre-visit questionnaires/calls to reduce time in office (if you use Ocean, consider questionnaire forms emailed to patient prior to visit)
• Virtual visit (e.g., phone call) the day before to ask prenatal/well baby or other history questions

Active screening as patients arrive in office

• Screening patients as they come in based on current symptom list.

Patient messaging – in office

• If waiting in car: call them to tell them when ready for them to come in, message through computer to text them (if this feature is available to you), , or use restaurant-style buzzer system
• Upon arrival: all patients use hand sanitizer and apply a mask if they do not have their own non-medical mask

Signage

• Sample screening poster
• Post current symptom list somewhere for patients to see as means of self-screening
• Public Health Ontario signage on how to wash hands and use hand sanitizer
• Respiratory etiquette poster
• Cover your cough sign
• How to safely use non-medical mask or face covering

Financial transactions

• Encourage clients to pay with tap where possible to limit need to handle money, limit need to touch Interac machines