Reopening Your Practice During Pandemic

As psychiatrists plan to reopen their offices, they first need to consult their local public health department, Board of Medicine, and the Centers for Disease Control and Prevention (CDC), Occupational Safety and Health Administration (OSHA), and APA guidelines. Guidance from public health and government authorities is likely to change as the COVID-19 pandemic evolves. All practitioners should follow the most current information on maintaining workplace safety.

In addition, consider these recommendations:

• Monitor state executive order expiration dates related to telemedicine, licensing, prescribing, and regulatory compliance, especially if you are providing telepsychiatry to out-of-state patients.

  • As executive orders expire, it may be necessary to obtain licensure in the states where the patients are located.

  • State-by-state guidance is available from APA here.

• Consider continuing telehealth visits when patients are high risk and do not require in-person visits and when the psychiatrist is at high risk.

• Follow the current CDC return-to-work guidelines for health care workers with confirmed or suspected COVID-19.

• Follow the U.S. Equal Employment Opportunity Commission guidance to determine whether and how to test and screen employees for COVID-19 during the pandemic.

• Consider opening the practice slowly with limited staff and rotating the staff who come into the office.

• Install barriers between patients and staff when possible, such as plexiglass at the registration and checkout areas.

• Redesign the waiting room and group therapy rooms to facilitate physical distancing, such as placing chairs six feet apart and reducing the number of patients in the office to one at a time.

• Create a written protocol and prescreen patients for COVID-19 symptoms and potential exposure during appointment scheduling and reminder calls and upon arrival to the appointment (may include temperature check).

• Require patients to sign an acknowledgement of the risks of coming into the office.

• Consider changes for “no contact” business operations, such as patients checking in by telephone and copays and other payments made by phone.

• Create structured office protocols and ensure consistency, including the following:

  • Require that every person in the office wear a face mask.

  • Require that patients call or text staff when they arrive for their appointment before coming into the building.

  • Bring patients directly to the session room and space appointments to allow for confidentiality, physical distancing, and cleaning.

  • Implement a no-visitor policy except for an adult accompanying a minor and/or unless required as reasonable accommodation. Be sure to screen visitors.

• Post signage at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette. You can look for those information on the C.D.C. website.

• Ensure there is adequate personal protective equipment available for patients, staff, and visitors in accordance with CDC and OSHA guidelines.

• Ensure appropriate and adequate cleaning and provide hygiene supplies in the waiting area and session rooms in accordance with guidances from OSHA and the Environmental Protection Agency (EPA), including no-touch hand soap, alcohol-based hand rub, disposable towels, no-touch trash cans, and tissues.

• Clean all session rooms and frequently touched surfaces with EPA-registered disinfectants before and after each patient (such as counters, seating, door handles, pens, clipboards, phones, and computers).

• Educate patients about safety protocols, office procedures, physical environment, and redesign. Consider creating a video on what has changed and post information on the practice or facility website.

• Update policies and procedures as regulations, guidelines, and office procedures change.

• Update your crisis management, business continuity, and communication plans.

While this is an unprecedented time in health care, these recommendations are meant to keep you, your staff, and your patients safe. ■

This information is provided as a risk management resource for Allied World policyholders and should not be construed as legal or clinical advice. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, Ltd., a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. © 2020 Allied World Assurance Company Holdings, Ltd. All Rights Reserved.