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PRACTICE MANAGEMENT
COVID-19 and Patient Safety
in the Medical Office
By Debbie Kane Hill, MBA, RN, Senior Patient Safety Risk Manager, The Doctors Company, Part of TDC Group
complied with community standards regarding access and delivery of services. Following an adverse event and litigation, plaintiff’s counsel would attempt to prove that the facility failed to follow what other similarly situated medical centers did in the same or similar situations; much would depend on whether the hospital complied with CDC guidelines and executive orders then in effect.
With communities around the country taking a variety of approaches to restrictions for public health, what are the latest considerations for keeping patients and staff safe within the medical office setting? Following are some suggested guidelines.
Managing the Unvaccinated
The highly contagious Delta variant has created what CDC Director Dr. Rochelle Walensky has called “a pan- demic of the unvaccinated.” While some read “unvacci- nated” as shorthand for “anti-vaccine” or “against the COVID-19 vaccine,” in fact, the unvaccinated population includes not only adults with certain medical condi- tions, but all children under 12 who are not yet eligible to receive a vaccine, as well as many adolescents who have not yet received their vaccine. Admittedly, however, most provider questions about unvaccinated patients pertain to adult patients who are eligible for a COVID-19 vaccine, but have declined it for various reasons.
Further, consideration must be given to the reason why a patient is not vaccinated. Recent U.S. Supreme Court decisions give further credence to religious freedom, especially in the COVID-19 environment. Some patients who are members of Christian Scientist, Jeho- vah’s Witness, Seventh-Day Adventist, Orthodox Jewish, or other religious communities may decline a vaccine on those grounds.
Therefore, in addition to completing patient visits
via telemedicine when appropriate, other options for seeing unvaccinated patients should be considered. One option is maintaining office policies and practices for infection control from before vaccinations were avail- able. These include the use of drive-through visits via automobile, pre-examination questions and screening, masking by patients and staff, social distancing, and frequent cleansing of surfaces. Another option is desig- nating one exam room with patients seen by only fully vaccinated clinicians wearing PPE to treat unvaccinated
Updated August 2, 2021: According to the Centers for Disease Control and Prevention’s (CDC’s) Vaccine Data Tracker, over half of the U.S. population has had at least one dose of the COVID-19 vaccine, with just under 50 percent being fully vaccinated (with vaccinated defined as being at least two weeks out from receiving a second dose of the two-part Moderna or Pfizer vaccine, or two weeks after Johnson & Johnson’s single-dose Janssen vaccine). For those age 65 or over, nearly 90 percent have received one dose, while nearly 80 percent of that demographic have completed the series. On July 27, 2021, the CDC updated their safety guidelines for individuals who have been fully vaccinated; however, medical prac- tices should note that these recent changes do not apply to patients and staff within healthcare settings. Recom- mendations for use of personal protective equipment (PPE) by healthcare workers remain unchanged.
Meanwhile, COVID-19 infections, driven by the Delta variant, have jumped nearly 60 percent. The spikes in infection numbers are prominent in places with lower vaccination rates, such as Florida, Texas, and Missouri. Hospital beds are once again running short in hard-hit locations. If treatment of non-COVID-19 patients is de- layed due to impacted hospitals and emergency rooms, healthcare providers may be concerned about liability risks. The question is invariably whether the hospital
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