COVID-19 and PPE: The first real test for OHTs

Yes, it took a pandemic to get me blogging again.

There’s a million things I could rant about right now, but I want to stick to what I think is the most important pressing issue that we face in our community clinics as we approach the inevitable escalation in COVID-19 cases.

Many community clinics are going to be soon running out of personal protective equipment (PPE), if they haven’t already.

The change in the recommendations that now state that only droplet/contact precautions are necessary for COVID-19 assessment has certainly helped, whereas previous requirements for an N95 mask were not feasible for the majority of primary care providers. Even still, droplet/contact precautions consist of gloves/gowns/mask/eye protection, and even the most prepared of offices will struggle to have sufficient stock of these in the coming weeks.

We are a 10-physician FHO that services nearly 14,000 patients in London, and we are down to 100 gowns, 3 boxes of surgical masks, 250 face shields, and a dozen or so boxes of gloves. That’s it. We can theoretically use a few cloth gowns we have at the office and launder them each day, but when we hit the end of our mask and eye protection supply, we cannot continue seeing patients with any respiratory symptoms, for the safe of our physicians and staff.

We have already taken steps to proactively limit the PPE we are having to use. Any patient with any respiratory symptoms or travel history is spoken to on the phone by the physician, who determines whether a virtual visit is sufficient to address their condition. For those few patients who do require an in-person exam, we have a drive-thru setup at our side door, separate from the rest of the clinic, where patients pull up in their cars, and the physician goes out to the car in full PPE to examine them.

But despite our innovations, we will run out of PPE eventually. And those patients requiring a physical examination will then need to be sent to the emergency department for evaluation. We have no choice.

Here is where the untapped potential of an OHT arises. Hospital and community care could be viewed as one seamless entity, working together for the success of patients, providers, and the overall system.

We don’t want to send these patients to the ER. The patients don’t want to go to the ER. And the hospital surely doesn’t want to deal with an even greater burden of patients coming through their doors.

Coordination within an OHT could include sharing resources, both physical and informational. While the hospital is likely struggling with a relative PPE shortage as well, their supply margins are likely nowhere near as tenuous as those in the community. Sharing PPE resources with the community, under strict accountability agreements, will allow for the ongoing evaluation of community patients, and prevent the hospital from quickly falling to the same capacity crises that we are seeing in hospitals across the world. In return, the hospital deserves to know exactly how that PPE is being used, for which patients, and for the data to feed back to the hospital and public health. There are also tech initiatives underway where the hospital and public health may want primary care to participate in data collection to track community patients who are under quarantine, with symptoms, etc., and part of this ask could be tied to an ongoing collaboration with primary care.

What else can primary care do to work with the hospital? We want to help decant non-respiratory patients from the ER as well, so we are happy to provide our contact information to the ER staff if patients arrive and are deemed appropriate at triage to be seen by primary care. We all have same-day appointments available, and can easily facilitate this.

For inpatients, are there patients close to ready for discharge who may need close monitoring at home if discharged a day or two early? Allow us the proper PPE, and many community physicians would be happy to add these to our current house call commitments.

Things are going to worse here locally with COVID-19, very quickly. While OHT relationships have been slow to warm in many regions, this type of crisis is perfect opportunity to create trust in hyper speed, in situations that are mutually beneficial to all parties. We need to start collaborating ASAP.

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