How to Safely Work with Patients in Outpatient PT Practices Post-Lockdown

It feels like the entire country has been in a state of hibernation for the past two months. As new instances of the novel coronavirus begin to decrease and an end to stay-at-home orders appears within our sight, people are itching to emerge from their caves and embrace the warmer weather. However, we’re not in the clear yet—and as patient volumes inch closer to pre-pandemic levels, it’s absolutely crucial that PT practices take precautions when working with new and returning patients. After all, despite an apparent flattening of the curve, the risk of infection is still present. Here’s what outpatient physical therapy practices need to do when seeing patients after the COVID-19 lockdown has been lifted:

Check your state and local laws.

As states begin easing restrictions on stay-at-home orders, they are also providing specific safety measures that practices must adhere to. For that reason, you must check your state and city guidelines to see if there are any rules or requirements for things like the number of patients allowed in the clinic at any one time and the use of personal protective equipment (PPE). This will tell you what, at a minimum, you’ll need to do to remain compliant. If you need help researching the requirements that apply to you, this US Chamber of Commerce resource is a great place to start.

Start slow.

Before you do anything, map out a game plan for reopening your practice to the public. It’s super important to include key individuals in the planning process—such as your clinical director, office manager, HR department, and, if applicable, your attorney—to ensure you have additional perspectives from, and communication across, the entire organization. That way, you can be sure everyone’s on the same page and enforcing the same protocol. You’ll also want to loop in any third-party vendors that are important to helping you run your business and designate one person to field patient feedback.

In a recent post, WebPT Chief Compliance Officer Veda Collmer, JD, OT/R, discussed strategies for reopening your clinic and explained that an effective work plan should account for the following:

• disseminating information on new clinic protocols to employees;
• communicating important information to patients;
• reviewing workplace safety policies;
• informing your referral sources that you’re accepting new patients;
• updating signage and online listings with your current hours of operation;
• stocking up on cleaning supplies and PPE;
• creating checklists to ensure you haven’t overlooked anything pertinent; and
• updating your cleaning protocol to adhere to CDC guidelines (more on that in the next section).

While you might be tempted to jump right into treating patients like you were before, doing so is highly inadvisable. A period of “soft reopening” (i.e., reopening incrementally) will help prevent a sharp increase in new COVID-19 cases as well as allow patients and providers to adjust to these new changes.

Follow all safety and sanitization guidelines.

As practices start opening their doors and allowing more patients into the clinic, it’s vital that they adhere to all sanitization and safety guidelines to avoid contributing to a spike in infections. The Centers for Disease Control (CDC) has released a bevy of materials outlining the safety precautions clinics should take when working with patients. Chief among them:

• cleaning and disinfecting all equipment and surfaces between patients; and
• using PPE (e.g., gloves, gowns, face mask, and/or face shield/goggles) during treatment. (Both patients and providers may use PPE.) 

It’s important to also adhere to social distancing guidelines while working with patients. Many states have issued specific requirements businesses must meet as they reopen, so as I mentioned above, be sure to verify your local laws. That said, here are a few things to consider beyond state and local guidelines (as adapted from this American Medical Association [AMA] resource):

• Modify your staff schedule to avoid high volume, and ensure patients do not come into close contact with one another.
• Add some padding to each appointment slot to prevent overlap.
• Ask any patient companions to wait in the parking lot if their participation in the appointment is not necessary.

Furthermore, the CDC advises practices to require all visitors to wear a cloth face covering. It’s crucial to explain this expectation to each patient (and visitor) before he or she arrives for a scheduled appointment. To assist with compliance, provide or direct patients to resources that explain how to make a cloth mask using common household items. Or, if available, provide each patient and visitor with an approved facial covering upon arrival. 

Only allow healthy patients on site.

Part of your reopening plan should include screening every patient at the start of his or her appointment. If a patient exhibits symptoms of COVID-19, he or she should not be allowed on site. According to the AMA, “For visits which must take place in person, administrative staff should contact the patient via phone within twenty-four hours prior to the office visit to 1) review the logistics of the reopening practice protocol and 2) screen the patient for COVID-19 symptoms.” The AMA also recommends using a script to conduct these conversations and has provided an example in this guide.

There will undoubtedly be times when you have to turn one patient away to ensure the health of all the rest—and your staff. You’ll want to have a script for this conversation as well so you and your staff can politely and clearly explain the reason for the precaution. (The AMA has also provided a template for this script in the aforementioned guide.) Patients who should not be allowed in the practice include:

• Those showing symptoms of COVID-19;
• Patients who have been in close contact with someone who is suspected to have/was diagnosed with COVID-19; and
• Patients who have recently traveled to high-risk areas.

If a patient displaying COVID-19 symptoms does enter your practice, be sure to sanitize any areas he or she might have touched.

Conduct virtual visits whenever possible.

Thanks to recent relaxations on telehealth restrictions, it’s easier than ever for PTs to not only conduct virtual visits, but also get paid for them. If your practice is not already taking advantage of this, you should do so now. That way, patients who cannot come into the clinic—whether they are displaying COVID-like symptoms or are part of a high-risk population (e.g., diabetics, the elderly, etc.)—can still receive care without putting themselves (and others) at risk.

We’ve covered this particular topic at great length in the past few weeks, so for more information, check out the following resources:

• 10 Steps to Get Up and Running with Telehealth in Your Clinic
• Download: Telehealth Billing Quick Guide for PTs, OTs, and SLPs
• How to Market Your Clinic’s New Telehealth Services

Educate yourself on best practices for working with COVID-recovered patients.

Finally, it’s highly likely you’ll work with at least one patient who has recovered from the novel coronavirus—especially if you live in an area that’s been hit hard by the pandemic. If so, you may need to adjust the way you work with these patients (e.g., factoring in break times when scheduling appointments for COVID-recovered patients, as they will likely need time to stop and rest throughout their treatment). While this is an ongoing learning process, the APTA has provided the following clinically-focused educational materials on working with patients who have recovered from COVID-19:

• APTA Cardiopulmonary Section webinar series
• COVID-19: Clinical Best Practices in Physical Therapy Management

To say the past two months have been challenging for physical therapists would be a serious understatement—but there is hope on the horizon. However, even as the number of new COVID-19 cases continues to follow a downward trend, it’s still critical to take every precaution to prevent a second wave. Doing so not only ensures the health of you and your patients—it ensures the health of everyone. Have questions about reopening? Let us know in the comment section below, and we’ll do our best to point you in the right direction.