Gurdesh Bedi, MD, FAANAllen Gee, MD, PhD, FAANMelissa Reider-Demer, DNP, MN, CNPMark Mintz, MD, FAAN, FAES

Key Considerations for Reopening a Neurology Practice

Slide 1© 2020 American Academy of Neurology

Zoom Webinar Tips and Notes

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• Audio: All lines have been muted• Technical Problems: Please use the “Chat” • Content Questions: Please submit

questions for the panelists using the Q&A button. Time has been allotted for Q&A at the end of the presentation

• Please fill out the post-webinar survey• The recording and slides will be available

on AAN.com on Friday, May 15th

© 2020 American Academy of Neurology

Questions for

Panelists

Technical questions

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Today’s Presenters

© 2020 American Academy of Neurology

Gurdesh Bedi, MD, FAAN• Director of Medical Specialties, Medical Director

of Kinisi Institute for Movement at St Croix Regional Medical Center – MN/WI

• Member of AAN Coding and Payment Policy Subcommittee

Allen Gee, MD, PhD, FAAN• Founder of Frontier NeuroHealth – Cody, WY• Member of AAN Medical Economics and Practice

Committee and AAN Quality Committee

Melissa Reider-Demer, DNP, MN, CNP • Multidisciplinary Nurse Practitioner and Acute

Care Lead at UCLA• Inpatient General Neurology and Operations

Quality Officer• Member of the AAN Care Delivery Subcommittee

Mark Mintz, MD, FAAN• Chief Medical Officer and Founder of NeurAbilities

Healthcare – NJ/PA • Member of the AAN Care Delivery Subcommittee

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Overview

© 2020 American Academy of Neurology

• Key Considerations for Reopening▪ General Operations▪ Safety - PPE, Cleaning▪ Scheduling▪ Workforce▪ Testing▪ Patients

• Q&A Session

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Disclaimer

This content is made available for voluntary, informational purposes and does not constitute medical or legal advice. The

views and opinions expressed do not necessarily reflect those of the American Academy of Neurology.

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Rationale for selectively reopening clinical operations

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Rationale for selectively reopening clinical operations

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General Operations• Remain flexible and strategic• Consult with federal, state and local guidance regularly• Evaluate your local situation and data before reopening• Open your neurology practice gradually• Continue practicing telemedicine as appropriate• Update your professional liability carrier of your reopening• Develop a plan to prepare for and manage future closings

Photo: Web PT

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General Operations

Source: St Croix Regional Medical Center, WI

• Consider defining an institutional COVID-19 risk and operational level framework based on the following:

▪ COVID-19 activity in local/regional area

▪ Surge indicators in state– Hospitalizations, ICU

admissions

▪ PPE, supplies, staff, other resources

▪ Regulatory and other guidance

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Individual Patient Decision-MakingA patient should be seen in person if the equation below favors a positive value; i.e., the risk of not intervening is greater than the risk of COVID-19 transmission and infection for a given patient.

Source: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html

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Safety• Establish a safe and effective patient screening and scheduling protocol• Assess and secure appropriate PPE and supplies• Develop practice protocol for sanitizing patient rooms and common areas• Minimize contact, maintain physical distance• Ensure practice supplies including medications are available and safe for use• Consult with building management on safety guidelines for tenants

XXX

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Scheduling• Develop a system to determine which patients

should be seen in person versus telemedicine, based on community and patient risk factors

• Implement pre-visit screening for in-person patient appointments

• Assess how scheduling of procedures will affect PPE, sanitization, and maximal scheduling capacity

• Extend practice hours to accommodate safety and cleaning protocols, maintain overall patient volumes▪ Early morning, evening, weekend hours

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Workforce• Develop staff policies for returning to work• Comply with federal guidance if a staff

member contracts COVID-19▪ CDC, OSHA

• Discuss changes to providers and support staff ability to return to work

• Establish frequent and open communication with staff

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Personal Protective Equipment (PPE)• Hand Hygiene

▪ Before and after using PPE• Develop training/protocols for staff and patients

▪ When and what PPE to use▪ Proper placement, use, removal, disposal▪ Cleaning and disinfecting reusable PPE

• Obtain PPE▪ Prioritize/ration PPE for HCP serving high-risk patients▪ Use of equivalent or substitute PPE▪ Identify sellers and other sources

Photo: CDC

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Types of PPE• Filtering Facepiece Respirators

▪ N95 or equivalent (FFP2, KN95, P2, DS2, Korea 1st class)

• Facemask▪ Acceptable alternative, disposable▪ Cloth masks are not PPE for HCP

• Eye protection: Face shield and/or goggles• Gloves: Disposable, clean, non-sterile• Isolation Gowns• Head and shoe covers

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Cleaning• Clean equipment and high touch

surfaces often

• Use soap and water to clean surfaces prior to disinfection

• Disinfect surfaces and equipment▪ Wear gloves▪ Ensure adequate ventilation▪ Maintain adequate supply of cleaning

solutions

• Water/Disinfection Bleach▪ Use 4:1 solution▪ Each batch is effective for 24 hours▪ Leave on surface for one minute▪ Wipe clean ▪ 70% alcohol solution: evaporates

▪ Soft Surfaces: soap and water; EPA-approved household disinfectants

▪ Electronics: wipeable covers; 70% alcohol wipes

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COVID-19 Testing• Useful for epidemiological studies• Necessary for mitigation and contact tracing• Necessary for hospitals and high-risk facilities• Necessary for medical/surgical treatment decisions• Community-based ambulatory health care facilities

▪ No direct federal guidance▪ Variable state/local guidance▪ As availability and accuracy of viral rapid tests improves, guidance may

change

This Photo by Unknown Author is licensed under CC BY-SA

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Communication with Patients• Set expectations, reduce fear, stay positive• Communicate types of visits available• Discuss safety and care plans with patients• Develop a plan for patients who are uninsured

or previously insured• Maintain detailed documentation for all patients

▪ Consider obtaining consents

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AAN Resources• COVID-19 Neurology Resource Center

▪ AAN.com/COVID19• Reopening Your Practice Resources

▪ AAN.com/reopening• Telemedicine Resources

▪ AAN.com/telehealth

• Financial Support Resources▪ AAN.com/view/practiceresources

• Have practice questions? ▪ Email the AAN: practice@aan.com

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Question & Answer Session