Telehealth visits

  • CMS implemented new telehealth guidance as of March 17, 2020
  • Clinicians may now care for new or existing patients remotely in any healthcare facility and in their home
  • Allows for billing of E/M service, voice-only services, and electronic/telephone/internet communications with patient or inter-professional assessment and management
  • State and commercial payer guidance varies greatly
  • Rules are changing frequently
  • Consult CMS guidelines for updates on these services https://www.cms.gov/

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PPE guidelines for physician practices

The CDC recommends the following PPE guidance for healthcare workers that are caring for patients of suspected or positive COVID-19

  • Assess and triage these patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a facemask on the patient and placing them in an examination room with the door closed.
  • Use Standard and Transmission-Based Precautions when caring for patients with confirmed or possible COVID-19.
  • Perform hand hygiene with alcohol-based hand rub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Use soap and water if hands are visibly soiled.
  • Practice how to properly don, use, and doff PPE in a manner to prevent self-contamination.
  • Perform aerosol-generating procedures, in an AIIR, while following appropriate IPC practices, including use of appropriate PPE.

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Environmental cleaning and disinfection

Routine cleaning and disinfection procedures are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed. Products with EPA-approved emerging viral pathogens claims are recommended for use against SARS-CoV-2.

For more updates on recommendations for PPE- visit https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-patients.html

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Hospital provider PPE guidelines

Make certain that you are wiping your disposable stethoscopes down with 70% Isopropyl alcohol ONLY.

Clean protective eye wear in between patients per HCA Healthcare guidelines.

Masks

All colleagues, regardless of whether they work in patient or non-patient care areas, are required to wear a mask. Your health and well-being is of the utmost importance and by applying this masking requirement, that exceeds the CDC guidelines, we are continuing to implement precautions to keep our workforce as safe and healthy as possible.

Process:

Upon arriving in your department and receiving patient assignments (for patient-care areas) for the day, the CNC/charge nurse or supervisor will pick up the necessary PPE for each staff member in the designated location. At the end of the shift, the CNC/charge nurse or supervisor will bag and return the N95 masks, face shields and goggles to the same location for reprocessing and disinfection. Level 1 and Level 3 masks should be discarded at the end of each shift.

Mask levels by work area:

All colleagues (except RT, intubation, ER and staff caring for COVID patients)

From PPE Czar:

  • Level 1 Mask

On Unit:

  • Gloves per usual care
Respiratory therapy and intubation team

From PPE Czar:

  • N95 Mask with googles or any face shield
  • Hospital Scrubs for RT
  • Isolation gowns

On Unit:

  • Gloves
COVID or suspect COVID, ED staff

From PPE Czar:

  • N95 or Level 3 Mask with googles or any face shield
  • Hospital Scrubs
  • Isolation gowns

On Unit:

  • Gloves

Masking guidance

Masks should be replaced when wet, damp, torn, visibly soiled or hard to breathe through. When masks are removed for one of these reasons, discard in usual containers. Masks should remain on when using the restroom. However, for meal and water breaks utilize a disposable container to store the mask, with the outside surface of the mask facing down on the container. If at any time you touch the mask, immediately follow with hand hygiene. Do not discard masks between patients.

Gown guidance

Caregivers of isolation patients, including COVID or suspect COVID, will receive up to 15 isolation gowns per patient per shift. For additional gowns, please see your supervisor.

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HCA’s visitation policy for patients within our hospital medical office buildings

(If you are at an offsite practice, we encourage you to have some kind of screening policy and visitor limitation in place that follow national and state recommendations)

To help reduce the spread of respiratory illnesses, we have restricted all non-essential visitors.  We will allow exceptions for:

  • One dedicated parent or caregiver for minor patients who cannot be left alone.
  • One dedicated partner for those with disabilities or impairments warranting assistance from a companion.

**Please note that any individual granted an exception who screens POSITIVE for respiratory illness will not be allowed in our facilities.

HCA facility labor/delivery patients

  • One support person for labor and delivery patients throughout their hospital stay.
  • One parent or guardian at a time for neonatal intensive care unit (NICU) babies.

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Elective surgeries at an HCA facility

As of Monday, March 23, HCA Midwest Health will postpone elective surgeries and procedures. This will assist in reserving supplies, resources, and blood products for future patient needs. This decision is consistent with recommendations from the American College of Surgeons, the Surgeon General of the Unites States, the White House Coronavirus Task Force, and CMS.

  • Tier 2: All cases should be postponed unless deemed clinically necessary
  • Tier 3: Continue cases as previously instructed. 

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Provider screening at HCA facility entrances

As the COVID-19 outbreak continues to rapidly evolve, HCA Midwest Health has instituted further heightened precautions to safeguard our patients, colleagues and physicians.

All providers, including physicians and staff, will now be screened using screening questions and a temperature check each time they enter our facilities. Physicians and staff will also be asked to complete hand hygiene with alcohol-based sanitizer before entering.

Thank you for your support and cooperation as we work together to slow the spread of COVID-19.

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