Guideline for COVID Surge Management in Outpatient Areas

To protect the health of both our patients and employees during the COVID-19 pandemic, UMMS ambulatory care practices have adjusted face-to-face appointment volumes, expanded the utilization of telemedicine care and put into place procedures to minimize the risk of COVID-19. It is critical that ambulatory care practices remain prepared to mitigate any stresses on System resources while providing access to timely care and maintaining our high-quality standards.

This policy provides guidance for practices as patient volumes increase. Factors to consider while planning for a surge in patients presenting for care include, but are not limited to, access, scheduling, location, staffing, triage standards, testing and treatment needs and transitional care models.

The recommendations and operational changes outlined in the full policy linked below are designed to prioritize safety for patients and employees. The attached Office-Based Appointment Checklist (found linked at the bottom of the policy) should be completed by each ambulatory care practice to ensure that the practice has all appropriate policies and procedures in place.

This policy was updated on December 3, 2021, to include a new planning process for entities to follow that will allow them to monitor surge awareness across the inpatient to outpatient continuum. The new process requires each entity to establish a planning team, create an activation process to move staff and/or providers to the greatest areas of need, and utilize a planning document that reflects the standardized surge level and the staff to be redeployed (an example planning document is attached to the policy, which can be adapted for local use). The updated policy also includes new requirements for assessing and reinforcing staff competencies prior to a potential deployment. Please review the full policy to learn more about these updates.

Together, we are forging new ground as each day passes in our response to the COVID-19 pandemic and its effect on our communities in Maryland. Thank you for your unwavering leadership as health care professionals in ensuring we continue to provide the highest quality care for our patients.

Click here to view the Guideline for COVID Surge Management in Outpatient Areas.

Are patients in ambulatory practices required to wear masks?

Yes. Patients and employees in ambulatory practices must follow the UMMS Universal Masking and Expanded PPE policy. That means that all persons must wear a face mask at all times. Additional PPE may be required for clinical providers due to patient’s COVID-19 status or ability to wear a mask.

What adjustments in workflows are recommended for in-person appointments?

Ambulatory care practices should aim to separate suspected and positive COVID-19 patients, as well as those presenting with influenza-like illness (ILI), from non-COVID-19 asymptomatic patients. This can be achieved by maintaining scheduling practices that separate these appointments as well as by designating separate locations or spaces to evaluate patients. Plans should include clear delineation of processes to maintain complete spatial separation between COVID-19 positive/ILI and non-COVID-19 immunosuppressed patients (e.g., cancer patients, transplant patients, etc.)

Should patients be screened for COVID-19 prior to their appointment?

Yes. All ambulatory care centers should have a process to conduct designated phone screening and clinical triage to determine patients who can safely be assessed via telemedicine, who potentially requires a face-to-face evaluation or who should be immediately referred to their local emergency department for emergent care.

How should we prioritize the scheduling of in-person appointments?

Utilizing local clinical and operational leadership in the decision-making process, practices should develop a patient prioritization process, accounting for the following factors:

1. Patient is likely to require hospitalization or an emergency department visit in the near future if not seen in person
2. Patient is part of a vulnerable population where the risk of deterioration in chronic conditions or functional deterioration is greater, and cannot be effectively assessed virtually
3. The patient requires pre- or post-operative evaluations for time-sensitive procedures
4. The patient has experienced outstanding gaps in care which may impact outcome and quality measures
5. The patient requires pre-operative evaluations for non-time-sensitive procedures
6. The patient is due for an annual screening
7. The patient requires sports or other physicals
8. The patient is a new referral

Are we still offering telehealth services?

Telehealth services are continuing and highly encouraged whenever possible. Providing care in a virtual format limits the risks for exposure to the COVID-19 virus for both patients and employees, while also conserving PPE inventories. Ambulatory care practices should create a plan to quickly modify in-person patient schedules, including the conversion of in-patient appointments to telemedicine, as needed, to accommodate a COVID-19 surge.

Are there additional infection prevention precautions for the ambulatory sector?

All ambulatory care practices should adhere to the UMMS System-wide PPE guidance to ensure that everyone who enters our facilities is properly protected while maintaining adequate PPE supplies. In addition, the guidance linked above contains an attachment – Infection Prevention Guidance for Ambulatory Practices During COVID-19 – that outlines additional infection prevention precautions that should be taken for any COVID-19 surge.