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What Dermatologists Can Do For Their Emergency Department Colleagues

What Dermatologists Can Do For Their Emergency Department Colleagues

Mon, 03/30/2020 - 19:21

Dr Noll

As of Monday, March 30, 2020, there are 144,672 confirmed coronavirus (COVID-19) cases in the United States. The virus has significantly impacted the US health care system, with emergency departments in epicenters overrun with cases in addition to the usual number of patients. In addition, there are shortages of personal protective equipment (PPE) that has left many on the frontlines exposed to the virus.

Samantha Noll, MD, Disaster and Operational Medicine Senior Fellow in the department of emergency medicine at George Washington University, answered The Dermatologist’s questions on how to prevent the spread and what dermatologists can do to help their colleagues in emergency medicine.

The Dermatologist: What precautions should providers take to reduce the spread of COVID-19 and potential exposure to at-risk patients?

Dr Noll: Some precautions providers can take include:

  1. Designate a time to educate your staff about COVID-19 and share useful resources from the CDC in addition to measures your clinic is taking.
  2. Encourage sick employees to stay home.
  3. Screen patients and visitors for symptoms of acute respiratory illnesses (for example fever, cough, difficulty breathing) before entering your health care facility.
  4. Place visual alerts (signs, posters, etc) at entrances and other strategic areas providing instruction on hand hygiene, respiratory symptoms, and cough etiquette.
  5. Ensure supplies are available (tissues, waste receptacles, alcohol-based hand sanitizer, etc).
  6. Create an area for spatially separating patients with respiratory symptoms. Ideally, all patients would be 6 feet or more apart in waiting areas.
  7. Have face masks available at entrances for patients with respiratory symptoms.
  8. Alcohol-based hand sanitizers with 60% or more ethanol and 70% isopranol is the preferred formulation in healthcare settings for hand hygiene. Use soap and water if hands are visibly soiled.
  9. Standard precautions should be followed when caring for any patient; specific precautions are not needed for patients that are afebrile and without even mild symptoms (cough, sore throat, shortness of breath) that might be consistent with COVID-19.

The Dermatologist: What are your recommendations for counseling patients and their caregivers on when to stay home verses when to see a doctor? What recommendations do you have for non-medical caregivers to protect themselves and their family?

Dr Noll: There are excellent resources from the CDC website for patients who are sick at home, including information for caregivers and when to discontinue home isolation: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html. Other points for patients who may call in and ask include:

  1. People who are mildly ill with COVID-19 are able to recover at home.
  2. Patients should stay in touch with their regular doctors to monitor symptoms. If their symptoms worsen or the patient experiences shortness of breath, they should contact their primary care provider.
  3. Emergency warning signs that require immediate medical attention include difficulty breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face. Patients or caregivers should call 911 for a medical emergency and notify the 911 operator that the patient has or might have COVID-19.

The Dermatologist: What might help alleviate the burden on hospitals and emergency rooms? How can providers take care of themselves during these times?

Dr Noll: The most important goal at this time is to maintain patient safety and protect the health care workforce. Some steps dermatologists and other providers can take to reduce the burden on emergency rooms and hospitals include:

    1. Ideally, reducing unnecessary health care visits and preventing transmission of respiratory viruses in your facility by:
      1. Trying to reschedule urgent inpatient procedures and visits to the outpatient setting.
      2. Reschedule non-urgent outpatient visits and procedures as necessary.
      3. Increase the use of telephone management and consider the use of a telehealth system.
      4. Eliminate patient penalties for cancellations and missed appointments related to respiratory illness.
      5. Symptomatic patients who need to be seen in a clinical setting should be asked to call before they leave home so staff are ready to receive them using appropriate infection control practices.
    2. Frequently wash hands with soap and water for at least 20 seconds.
    3. If you have an unprotected exposure to a confirmed or possible COVID-19 patient, call your occupational health team or supervisor immediately and plan to stay at home until further notice.
    4. If you are sick, stay home.

In addition, providers can consider donating personal protective equipment to frontline healthcare workers temporarily.

Resources

AAD: https://www.aad.org/member/practice/managing/coronavirus

CDC: https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html

FDA: https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/faqs-shortages-surgical-masks-and-gowns

Reference

1. Coronavirus COVID-19 Global Cases. John Hopkins University Center for Systems Science and Engineering. https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6. Updated March 23, 2020. Accessed March 23, 2020.Image removed.

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