Otolaryngology practices are scheduling more office visits after severely curtailing them in mid-March when the COVID-19 pandemic took off in the United States. Masks, Plexiglas shields at check-in counters, and telemedicine are the new normal in otolaryngology, physicians say.
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August 2020Practices that are successfully reopening have installed safety precautions to help prevent transmission of SARS-CoV-2, the novel coronavirus that causes COVID-19, although each facility follows different official recommendations.
Protective Practices
“We’re following the COVID-19 safety guidelines from the CDC, but we also adhere to our state’s guidelines. It varies county by county, depending on what phase we’re in, and that’s based on the number of cases and deaths,” said Kathleen C.Y. Sie, MD, division chief of otolaryngology–head and neck surgery and the Richard and Francine Loeb Endowed Chair in Childhood Communication Research at Seattle Children’s Hospital. Seattle saw some of the earliest COVID-19 cases in March, so her hospital had to adapt quickly. An emergency operations council sets all safety policies. “We didn’t have anyone else’s lessons to follow, but we had a well-defined plan to put in place earlier than some other cities,” she said.
Seattle Children’s Hospital screens all individuals, including patients, families, and staff, as they come into the building. Each person is asked screening questions about possible COVID symptoms, and their temperature is taken. “If they don’t pass those two things, then they’re denied entry,” Dr. Sie said. “Patients are asked to reschedule their appointments, and staff are asked to have COVID testing. We provide everyone who enters with masks. We have tape on the floor to mark 6 feet of distancing. Even our cafeteria has changed. We used to have a salad bar, but now all food is prepackaged.” Providers wear masks throughout the campus, and masks and face shields in patient care areas. Rapid coronavirus testing is available, with results in 50 minutes.
More people are now wearing scrubs in the hospital and changing into their street clothes before they go home. You see fewer people wearing a suit and tie. —Brandon Hopkins, MD
Masks are mandatory for all staff and patients at ENT Associates at Greater Baltimore Medical Center, which also recently installed Plexiglas shields at check-in counters, said otolaryngologist/head and neck surgeon Marc G. Dubin, MD.
“Social distancing starts at the front door as everyone stands in line to get their temperature taken. Patients must come alone unless they truly need physical assistance or are a minor,” he said. “Patients are asked screening questions about COVID-19 symptoms and exposure before the appointment is made, and again at the front door prior to entry.” Questions include whether you’ve visited an area with a high rate of COVID-19 cases or have potential symptoms.
Dr. Dubin said he’s comfortable with the level of safety and protection at their offices throughout Maryland. “We have the PPE [personal protective equipment] we need, we’re social distancing, we’re testing our surgical cases, and we’re wearing masks,” he said. The group employs more than 60 otolaryngologists, and in mid-March restricted in-person visits to urgent or emergent cases only. In late May, the group expanded clinic visits to include routine care. “With our protocols in place, we’ve had no cases of patient-to-staff, staff-to-staff, or patient-to-patient transmission within our facilities.”
At Cleveland Clinic’s main campus in Ohio, masks weren’t mandatory for every hospital visitor at first, but as national guidelines changed, the institution updated its stance and they’re now required for everyone, said Brandon Hopkins, MD, a pediatric otolaryngologist.
“Even before universal ‘cough etiquette masking,’ we implemented policies to make sure we had appropriate PPE for people in high-risk situations. Our infectious disease team and administrators have been leading this effort. They did everything in their power to protect our highest-risk patients and personnel,” Dr. Hopkins said. The Cleveland Clinic follows COVID-19 safety guidelines from the CDC, World Health Organization (WHO), and its own infectious disease department, requiring masks and social distancing within the hospital. “They’re looking at the evidence, and they’re considering what’s the most practical approach and what’s best for our local community.”
The Cleveland Clinic has designated specific entryways for all visitors and staff, where universal thermal screening is conducted, Dr. Hopkins said. At first, masks were provided to staff only, but as PPE supplies ramped up in spring, masks were given to visitors as well.
Physicians sport a new look from head to toe at the Cleveland Clinic, he added. “The culture has changed. More people are now wearing scrubs in the hospital and changing into their street clothes before they go home. You see fewer people wearing a suit and tie. White coats are being laundered more frequently than usual.”
At Colorado ENT and Allergy’s four offices in Colorado Springs and Monument, Colo., masks or other mouth and nose coverings are mandatory, chief executive officer Kevin Watson said. Patients must come to appointments alone unless they are minors or have special needs.
“We screen patients at the door to ask them if they have COVID-19 symptoms and to take their temperatures,” Watson explained. “If they’re over 100.6 F, we ask them to reschedule their appointments. We don’t have tape on the floor—we’re fortunate in that our main offices have fairly large waiting rooms. This allows us to perform social distancing.”