Recommendations for Dermatology Office Reopening in the Era of COVID-19

July 2020 | Volume 19 | Issue 7 | Original Article | 22 | Copyright © July 2020


Published online June 26, 2020

Suleima Arruda MDa, Doris Hexsel MDb, Tingsong Lim MDc, Heidi A. Waldorf MDd, Ofir Artzi MDe, Whosung Choi MDf, Sahar Ghana MD PhDg, Huang Gaomin MDh, Wilson Ho MDI, Maria Cristina Puyat MDj, Elena Rossi MDk, Ava Shamban MDl, Sonja Sattler MDm, Neil Sadick MDn

aArruda Dermatology, Sao Paulo, Brazil bBrazilian Center for Studies in Dermatology, Porto Alegre, RS, Brazil cClique Clinic, Kuala Lumpur, Malaysia dWaldorf Dermatology Aesthetics, Nanuet, NY; Icahn School of Medicine of Mount Sinai, New York, NY eTel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel fPiena Aesthetic Clinic, Seoul, Korea gAlexandria University, Alexandria, Egypt; Sahar Polyclinic, Salmiya, Kuwait hShanghai WanTian Cosmetic Medical Management Consultancy, Shanghai, China iThe Specialists: Lasers, Aesthetic and Plastic Surgery, Central, Hong Kong jRizal Medical Center, Pasig, Philippines kHead and Neck Skin Cancer Service, Modena, Italy; Reggio Emilia University, Modena, Italy lAva MD, Santa Monica, CA; SKIN FIVE, Los Angeles, CA mRosenpark Klinik GmbH, Clinic for Aesthetic Dermatologic Surgery and Plastic Surgery, Darmstadt, Germany, nWeill Cornell College of Medicine, New York, NY

patients, to avoid the risk of clothing as a transmission vector.

Office Operations and Management
Under normal circumstances, maintaining a smooth-running dermatology practice is not an easy task. There are constant challenges for which professionals need to be prepared to provide quality care for their patients. With the COVID-19 pandemic, even long-standing, successful policies may need to be altered or completely rewritten from patient scheduling, to visit-day details, and all associated alterations needed to staffing and supplies.

Personnel
• In order to maintain social distancing, it is recommended that only essential staff be onsite. In some offices, receptionists and billing staff may be able to work remotely if compliant with country and local privacy regulations.
• Staff must be educated on policies and practices to recognize symptoms and minimize chance of exposure to respiratory pathogens including SARS-CoV-2 and how and to whom to report concerns.
• Policies that promptly alert key staff about known suspected COVID-19 patients need to be implemented. Follow up of positive or suspected cases of COVID-19 must be done per department of health directives.
• Institute a plan of action in case of office staff illness, absences, and/or quarantine. All such plans should be in compliance with government department of health regulation and local labor laws.
• Where possible, it may be useful to cross-train staff for all essential office and medical functions.
• In multi-provider offices, staff may be divided into teams working in different areas and/or at staggered schedules. In that way, only the team exposed to a COVID-19 patient will require quarantine, not the full office staff.
• Monitor staff compliance with standard precautions and provide mechanisms for improvement as needed.

PPE Supply and Cleaning Procedures
• Review proper office and medical cleaning routines. Patient rooms must be sanitized before and after each patient visit. Always allow fresh air in between one patient and another.
• Identify PPE supplies required for care to be delivered during an outbreak or pandemic, and suitable suppliers.17 • Anticipate delays in shipping and delivery and stock up on commonly used products in advance. • Service all equipment and keep their service inspections up to date.
• Professional office cleaning services used daily or more frequently must be evaluated for their use of appropriate cleansers and PPE while in the office Scheduling and Triage of Patients
• Depending on the size of the clinic, limit the number of patients seen per day in order to maintain safe distancing in all public spaces. • Consider scheduling high risk patients (elderly) at specific times of day to avoid their contact with other patients. • Add an extra 15–30 minutes between patient appointments to allow treatment rooms and equipment to be sanitized and patients to enter and exit separately.
• Practices may need to extend daily office hours and the days of the week offered to allow more patients.
• In order to minimize multiple points of exposure, if possible, patients should be taken upon arrival to a single treatment room in which preparation (including topical anesthesia if needed), treatment, and post treatment acts are performed. This coordination must be determined prior to the patient arrival and may affect the number of treatments that can be performed during one visit.
• A final confirmation of the patient appointment that includes triage regarding potential COVID-19 related symptoms should be done 24–48 hours prior.
• Schedule telemedicine visits if patient does not require procedure.

Pre-Consulting
The experts discussed how a day-to-day life will look like in this new COVID-19 era. This will vary depending on the size of the practice, the number of office locations, the office space, and the type of patients providers see. The end goal however is to keep in-office appointments as short as possible and minimize the patients contact touchpoints in the clinic.

• All providers, staff, and patients are screened for COVID-19 symptoms at the entrance of practices and given a temperature check with a “no-touch” thermometer.
• System is in place either for communication between office staff and patients to time patient entrance into the clinic. In either case, the patient will wait either in their car or curbside until they have been told to enter.
• Unless necessary for medical reasons (disability, health impairment, a minor), each patient must enter the clinic unaccompanied by friends, family members, or children.
• Patients will be instructed to sanitize hands prior to or upon entering the office and those without a mask will have one left for them outside the door along with shoe covers.
• All incoming patients are directed to an additional hand sanitizer or to the bathroom to wash their hands prior to their visit.
• One nurse/medical assistant is assigned per patient.
• Patients must wear a mask throughout their time in the clinic except when the face is specifically evaluated or treated. A clean mask is applied immediately after.
• Depending upon the office layout, payment and follow up scheduling may be done online, in the treatment room, or with contactless payment at reception desk.
• Patient room is sanitized/cleaned before and after each visit: