AAP Voices Blog

We have had 11 patients test positive for COVID-19 — or 13% of all patients we have tested. Even though these children experienced only mild symptoms, we have documented them spreading it to other family members. That is why testing is so crucial. 

Here is the daily routine we mapped out to ensure we are keeping our patients and staff safe:

8:30-11:30 a.m.: Wellness checks for children 2 and younger. We try to slot our newborns in the first appointment of the day. 

11:30-12:30 p.m.: Catch-up, phone calls, complete cleaning of waiting rooms and telemedicine visits using doxy.me. We are trying to encourage use of telemedicine when appropriate. 

1:30 p.m. to close: See sick patients. 

We are wiping down all surfaces with CDC-approved cleaner in-between every patient. 

And we are asking all patients to wait in their cars instead of in the waiting room to ensure social distancing. Here is how that routine works:

• The patient calls the receptionist when they arrive and leaves a phone number. Meanwhile, the receptionist completes any check-in tasks, such as confirming insurance, etc. 

• The receptionist then changes the patient status to "PARKING LOT,” which is a new location we created in our electronic medical records system. This alerts staff that the patient has arrived.  
• The nurse will call the patient when she is ready to bring the patient to the exam room. 
• On this phone call, the nurse takes the patient’s entire history and asks COVID-19 screening questions. This limits our staff’s exposure to sick patients and determines whether we test for COVID.
• Here are our screening questions:
• Is the patient showing any signs of respiratory distress, such as increased respiratory rate, shortness of breath, increased work of breathing? If yes, then go to the ER. 
• Any known contact to someone who tested positive for COVID-19? If yes, find the source of contact. 
• Does the patient have any special health-care needs (diabetes, congenital heart disease, asthma, immunosuppression, IBD, etc.)? 
• Are the parents leaving the house for work? 
• Are parents/caretakers health-care professionals, first responders or other essential employees? 
• Any direct household contacts of the patient who are elderly, immunosuppressed or other high-risk conditions? 
• Upon arrival, the nurse takes everyone’s  temperature.
• We are not doing any nebulizer treatments in the office. If patients have a history of asthma, we ask them to bring their inhalers with them to the appointment. If we do a procedure that has any risk of aerosolization, we do it outside in our tent, which we take down every day. 
• Every day we have a designated tester, either a doctor or nurse practitioner, who does not have a schedule of patients. The tester comes in at 11:30 a.m. and has a designated nurse to assist with forms, gowning, etc. He or she stays until all sick patients are seen. The tester performs all tests: strep, flu, COVID, etc.
• If the patient needs testing, the doctor changes the patient status to “TESTER,” which is another new add to our record system. 
• Then the testing assistant nurse will be able to see the orders to prepare testing (labels, lab slips, etc.). The patient is asked to return to the car and directed to the tent. Testing is either done with the patient in the car or, if that is not feasible, the parent is asked to unbuckle the child, hold the patient on his or her lap, and face the child toward the window with the car door open. 

All staff wear surgical masks, including receptionists. Our providers and clinical nursing staff also have one to two N-95s that they are re-using. The N-95 used by the tester is placed in a bag and sealed for three or more days (usually 6-7 days) and then re-used on the next day. 

All shields and goggles are cleaned between patients. 

The tester nurse assistant wears N-95, eye protection and gloves. The nurse is at least 6 feet away when testing occurs. 

The tester wears an N-95 mask, eye goggles, gown, double gloves and has a plastic face shield (looks like Darth Vader) for testing. The nurse assists the tester in donning and doffing PPE. 

After testing for COVID, nurses call and check on patients daily until test results are known. All test results are given via a telemedicine visit with a provider, whether positive or negative. 

Every sick patient wears a surgical mask. We have always had this policy during flu season. I keep thinking, “Well, when we run out of PPE or tests, we will make a new plan.” But people have been incredibly thankful for our presence and generous in giving surgical masks. 

We are asking dentists, veterinarians and other businesses that use surgical masks for donations. We have bought more face shields from cleaning supply companies. We launder the gowns in our personal washing machine with bleach. (We read the labels, and who knew they were washable?) I reached out to someone I know who owns a mold remediation company and he donated two boxes of N-95s. 

This is jungle medicine, and we are trying to be creative in how we approach serving our patients.  

We will send some of the staff home early if we don’t have enough sick patients to fill appointment slots in the afternoon. These decisions are made on a day-to-day basis. We have also applied for a PPE loan so that we have the funds to meet staff payroll. 

Send in your COVID-19 pandemic story to our Story Bank, and we may share it here and on our social media channels.