“We have new concerns for our patients, staff, family and ourselves. In addition to providing excellent care to our patients as we’ve always done, we must now provide this care with enhanced safety procedures and help our patients and staff overcome the fear of leaving their homes while we deal with enormous financial issues,” said Eric D. Donnenfeld, MD, moderator of a two-part ASCRS special session symposium.
The pandemic provides a unique challenge for ophthalmologists whose patient examinations typically necessitate long periods of face-to-face exposure, Matt McCarthy, MD, an infectious disease specialist and assistant professor of medicine at Weill Cornell Medical Center, said.
Unless point-of-care COVID-19 testing is used at clinic and results are delivered in minutes, ophthalmologists will have to use universal precautions, assuming all patients are infectious even if they do not have symptoms, McCarthy said.
Precautions need to be taken for patients, staff, employees and physicians in every aspect of care. A vaccine may or may not be available by early 2021. Most vaccines take years to develop and, in some cases, vaccines are developed for decades and fail, he said.
“As you think about going back to work, reopening your practice, keep in mind that a vaccine probably won’t be available soon,” he said.
Everything will have to be considered, from waiting room procedures to interaction between patients and employees, Francis S. Mah, MD, said. Masks for all employees and physicians, whether surgical masks or cloth masks, will help reduce the spread of the virus.
“It does reduce spread. The biggest issue is that 20% to 30% of patients are asymptomatic carriers of the coronavirus. There’s another 20% to 30% that have mild [symptoms] or are pre-symptomatic or post-symptomatic, who can spread the virus unknowingly,” Mah said.
Practices need to develop re-opening teams to devise strategies to limit exposure, to organize new check-in procedures and pre-appointment calls to screen for potential COVID-19 symptoms, design new waiting room configurations to allow for social distancing and develop extensive cleaning procedures for the clinic, he said.
Adopting a curbside check-in process has been an effective way to manage contact and reduce waiting room exposure, Daniel D. Chambers, MBA, COE, chief executive officer of Key-Whitman Eye Center, said.
The Key-Whitman Eye Center has started seeing patients again and began with a tiered patient-flow system. During its first week open, only 33% of its patient volume was scheduled. In its second week, 50% were scheduled, and by Memorial Day 80% of patients will be scheduled, Chambers said.
More telemedicine visits were scheduled for interested patients and a new hybrid diagnostic visit was created.
“Patients could potentially come in and have a visual field, a fundus camera, an OCT and then leave. Those pictures are then examined for those established patients and then followed up with either telemedicine or a call with the patient. We found these to be particularly useful,” he said.
Gradual reopening of ambulatory surgery centers is beginning to happen as well. Owners should look to the federal government, local state departments of health, the Centers for Medicare and Medicaid Services and other organizations for reopening guidelines, Regina S. Boore, RN, MS, BNS, CASC, said at the symposium.
Supply and testing management will be crucial for reopening ASCs. Procedures for limiting contact in the centers and detailed training and infection control guidelines will be a necessity, according to Boore. – by Robert Linnehan
Reference: Donnenfeld ED. Turning the lights back on: Part 1. Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 16-17, 2020 (virtual meeting).