My mom’s ER is handling this so abysmally. They are basically exposing the entire ER to patients suspected of being positive. The pandemic is barely here and they are already low on PPE. She is over 60 with a comorbidity. I am trying to convince her to take a leave and then quit if needed. My parents can live with us if she doesn’t have pay. It’s just the insurance I worry about. If the hospital was taking care of her and the other nurses, I would feel differently, but there is too much risk.
The president of the Ohio Dental Association, a woman, is the first one to come out and tell dentists to GO THE F*** HOME. For the sake of having masks and gloves. Here is the best part of what she wrote -
"As for the order. From this time until after this pandemic has peaked, your office should be on emergency only status. The goal is to preserve Personal Protective Equipment (masks and gloves) and protect our patients and staff from the Corona virus. NO CLEANINGS OR PROPHIES should be performed on patients that do not have an emergent periodontal problem. DO NOT start any crowns, fillings, etc. unless it is the only way to relieve pain. DO NOT treat orthodontic cases unless it is an emergency. DO NOT do any cosmetic procedures. DO NOT treat those patients in high risk categories. Period."
I'm embarrassed at my profession. That other dentists have to be told what exactly constitutes a dental emergency and are not smart enough to figure it out for themselves despite earning a professional degree. So many still have their heads in the sand that this is all a conspiracy or the "government can't tell me what to do" or enter whatever lame excuse they're spouting.
Well at least that makes it pretty clear what dentists should be doing! Sorry that you have to close your business for now.
72 hours with a positive?! No quarantine if exposed to a positive person?
No wonder this virus is spreading so quickly. The different restrictions and criteria for testing and what PPE is needed changes every day.
No quarantine with confirmed exposure seems to be commonplace in the health care setting now, unfortunately. It's the policy at my hospital and 2 other RNs I've spoken to in other states have the same policy now.
I'm currently volunteering on my hospital's COVID floor for the day. (During emergency situations, non clinical staff can get redeployed to other areas where there is need.) I'm in charge of making sure no visitors come in. The staff here are saints.
72 hours with a positive?! No quarantine if exposed to a positive person?
No wonder this virus is spreading so quickly. The different restrictions and criteria for testing and what PPE is needed changes every day.
Yeah definitely things are changing very quickly.
My work today did just clarify that we’re following our state department of health which has similar guidelines. You can return to work 72 hours after no fever or any symptoms. Research has shown so far that very little viral shedding is happening at that point. So it’s a balance between protecting everyone and having enough healthcare workers available.
Post by wanderingback on Mar 19, 2020 12:32:20 GMT -5
So we’ve mostly gone to telephone/video visits. So far it seems to be going ok. People are still coming in for urgent visits and procedures that can’t wait. Testing for covid19 still seems a little limited but getting better. We’re trying to do a lot with staffing so more people can work from home and people can take longer shifts in the clinic without getting burned out. From the inpatient side things are definitely getting more busy with more and more cases.
For abortion care since in my city there is pretty good access places are consolidating to less clinics but still providing care. Trying to do a lot more abortion care via telemedicine for people to get pills, but stupid regulations are preventing that from fully happening.
I hope everyone is adapting ok to the changes! One day at a time.
72 hours with a positive?! No quarantine if exposed to a positive person?
No wonder this virus is spreading so quickly. The different restrictions and criteria for testing and what PPE is needed changes every day.
Yeah definitely things are changing very quickly.
My work today did just clarify that we’re following our state department of health which has similar guidelines. You can return to work 72 hours after no fever or any symptoms. Research has shown so far that very little viral shedding is happening at that point. So it’s a balance between protecting everyone and having enough healthcare workers available.
I had read 24 days after onset of symptoms. Can you share where you’re seeing this? 14 day quarantine even just for exposure is still happening here, and I don’t see how it’s sustainable.
My work today did just clarify that we’re following our state department of health which has similar guidelines. You can return to work 72 hours after no fever or any symptoms. Research has shown so far that very little viral shedding is happening at that point. So it’s a balance between protecting everyone and having enough healthcare workers available.
I had read 24 days after onset of symptoms. Can you share where you’re seeing this? 14 day quarantine even just for exposure is still happening here, and I don’t see how it’s sustainable.
Our medical director verbally confirmed that with us but I’ll see if it’s our daily update email or on state’s department of health page for healthcare workers. I’ll DM you.
My work today did just clarify that we’re following our state department of health which has similar guidelines. You can return to work 72 hours after no fever or any symptoms. Research has shown so far that very little viral shedding is happening at that point. So it’s a balance between protecting everyone and having enough healthcare workers available.
I had read 24 days after onset of symptoms. Can you share where you’re seeing this? 14 day quarantine even just for exposure is still happening here, and I don’t see how it’s sustainable.
wanderingbackfryjack2, and anyone, lol, my H’s coworker with the welding mask made all of the nurses involved shower after a code last night. He is making shit up as he goes. Thankfully he’s off for the next 7 days so hopefully he can calm down a bit.
wanderingbackfryjack2, and anyone, lol, my H’s coworker with the welding mask made all of the nurses involved shower after a code last night. He is making shit up as he goes. Thankfully he’s off for the next 7 days so hopefully he can calm down a bit.
My work today did just clarify that we’re following our state department of health which has similar guidelines. You can return to work 72 hours after no fever or any symptoms. Research has shown so far that very little viral shedding is happening at that point. So it’s a balance between protecting everyone and having enough healthcare workers available.
I had read 24 days after onset of symptoms. Can you share where you’re seeing this? 14 day quarantine even just for exposure is still happening here, and I don’t see how it’s sustainable.
.
Also, I read another email and if we are positive, we have to be out 7 days from the start of symptoms as well.
Post by wanderingback on Mar 19, 2020 14:06:11 GMT -5
tacocat it’s not sustainable to quarantine healthcare workers for 2 weeks after exposure. There would be no one left to work to take care of patients.
I’m in an area of community spread and it’s already starting to get difficult to staff with people calling out with any minor symptom (which is the right thing to do), so there’d be no way to take care of patients if we also had to quarantine for 2 weeks for any exposure.
So at this point focused on taking temps and monitoring for any symptoms. Many of us typically work while sick, but now we really are supposed to be more cautious.
tacocat it’s not sustainable to quarantine healthcare workers for 2 weeks after exposure. There would be no one left to work to take care of patients.
I’m in an area of community spread and it’s already starting to get difficult to staff with people calling out with any minor symptom (which is the right thing to do), so there’d be no way to take care of patients if we also had to quarantine for 2 weeks for any exposure.
So at this point focused on taking temps and monitoring for any symptoms. Many of us typically work while sick, but now we really are supposed to be more cautious.
Yeah, it does make sense. I am concerned about people who don't show symptoms and can pass it on. I don't know the solution to that though. Our nurses and CNAs are typically in the 20-29 yo age group that are asymptomatic. Maybe they just need the olds like me, lol.
My H was already having to use the same N95 mask repeatedly, now they have to use the same gowns. This is going to be a humbling experience for America, I can only hope some good comes our of it. Hope is my mantra right now.
All this stresses me out. Working with heavily immunocompromised patients has made us obsessed with being clean. I worry we won't have what we need to protect them, let alone ourselves.
My H was already having to use the same N95 mask repeatedly, now they have to use the same gowns. This is going to be a humbling experience for America, I can only hope some good comes our of it. Hope is my mantra right now.
N95 possibly? They’re doing some studies to show how it can be done “safely”.
Same gown? For different patients? Absolutely not.
I only read about 3 pages of the thread, so I'm sorry if I missed anything. Are any of you home health care workers? What are you companies doing? I am a HH OT and for now we are all required to take our temps every morning, and also call each patient prior to our appointments to ask questions to determine if they have been around anyone posing a risk of illness since the last time they were seen by us. I'm semi-high risk with a history of asthma, whooping cough, pneumonia x2 and bronchitis numerous times, so I truly hope that this is best practice for the time being. Anyone in our company who has been in a high risk area (certain counties in the mountains where the number of cases are higher) has a 14 day quarantine. Also, our social workers and chaplain are doing phone visits.
on an aside, I have had a toothache getting progressively worse since last Friday and can't get into a dentist, so that's been super fun, but understandable.
I'm in western PA so we only have a few dozen confirmed cases in the area, minimal hospitalizations and no community spread yet so we are a week or so behind you guys.
Was there an eerie lack of activity before it got crazy? There are a few hospitals in our system and since last Friday hospital census has dropped significantly and is currently 50% of what we expect around now (not including the canceled elective surgeries- the last of those were still done this week).
It feels ominous- I know its going to get bad, we're just waiting for it to start. There's been a bunch of tests sent out and none are positive so far but this "trial run" of false alarms is not leaving us very confident in our policies and directions.
N95 possibly? They’re doing some studies to show how it can be done “safely”.
Same gown? For different patients? Absolutely not.
It’s awful. I hope we get supplies soon.
ETA: orangeblossom - I was mistaken, I don’t know if this is better or worse, but they are all resuming the same gown with one pt. They all have their own N95s and are reusing the same gown/room.
Still bad, because how are they getting the home off in a way that keeps it intact, and putting back on used gown seems impossible not to to touch the front where the germs are.
It's all abysmal, and that the CDC actually said for people to use bandanas when all else fails is just unreal. Like, really, this is your suggestion?
This is what it has come down to. My hospital admitted it doesn't have enough equipment. If it comes down to going to work and having to use a bandana, I'm out. I have two young kids both with lungs that aren't that amazing when they get sick thanks to being born premature. Literature is coming out that kids are in fact getting this virus. I have zero ethical issues making that call. 10 years ago when I didn't have kids? I would prob report to work still. Again, I'm so pissed at our government for ignoring China and Italy's warnings.
I have also lost a lot of faith in the CDC. From N95 mask to surgical mask to a bandana. Seriously? I get that they are essentially saying use whatever you can as a barrier but come on.
I'm in western PA so we only have a few dozen confirmed cases in the area, minimal hospitalizations and no community spread yet so we are a week or so behind you guys.
Was there an eerie lack of activity before it got crazy? There are a few hospitals in our system and since last Friday hospital census has dropped significantly and is currently 50% of what we expect around now (not including the canceled elective surgeries- the last of those were still done this week).
It feels ominous- I know its going to get bad, we're just waiting for it to start. There's been a bunch of tests sent out and none are positive so far but this "trial run" of false alarms is not leaving us very confident in our policies and directions.
I'm in western PA so we only have a few dozen confirmed cases in the area, minimal hospitalizations and no community spread yet so we are a week or so behind you guys.
Anecdote time, but they’re not yet seeing community spread there in part because they’re not testing for it! My stepmother attempted to get a test on Monday. She has had all the symptoms, but no known contact with anyone who had traveled to a hot zone and her pulse oxygen was high enough that day (has since gone down at home) that she was refused a test. We’re pretty sure her only exposure came from a grocery store outing on March 5 (seven days before the onset of symptoms). But let’s keep our eyes closed, and we won’t see that until it gets ugly, and all these people have continued to move around in the meantime before the governor’s actions took effect, because they think no one around them is sick. It’s infuriating and people are going to die because of the lack of tests and resulting transparency.
Sorry I’m just pissed and worried. I really appreciate the work you’re about to do klee23, and at the same time, I hope it isn’t on someone in my own family. (My stepmother seemed a little better yesterday over the phone, but her lungs still sound awful.)
ETA I’m not blaming anyone providing care for the lack of tests, I know they are rationing and have tough calls to make with limited resources. I appreciate that even attempting to get tested was an option. I’m just worried for the fallout too.
Post by wesleycrusher on Mar 20, 2020 7:53:10 GMT -5
minzy yes it's not that we don't want to test people, the issue is we just don't have the number of tests needed! I posted an article in the news thread yesterday about the difference in S Korea and here and it made me even more angry at the thumb twiddling that went on from out government.
I work for Western PA's major hospital system, in outpatient psychiatry. I am amazed at how seriously my office has taken this- in under a week our office which sees hundreds of patients per day has gone almost entirely to televisits and plans to be completely remote next week. I would have never though it possible with the severity of patients we see and the groups we run, the amount of staff, the insurance reimbursement issues. Our management has really done an excellent job with this.
minzy yes it's not that we don't want to test people, the issue is we just don't have the number of tests needed! I posted an article in the news thread yesterday about the difference in S Korea and here and it made me even more angry at the thumb twiddling that went on from out government.
I work for Western PA's major hospital system, in outpatient psychiatry. I am amazed at how seriously my office has taken this- in under a week our office which sees hundreds of patients per day has gone almost entirely to televisits and plans to be completely remote next week. I would have never though it possible with the severity of patients we see and the groups we run, the amount of staff, the insurance reimbursement issues. Our management has really done an excellent job with this.
Yeah same here. We serve a highly underserved patient population with complex needs. But so far we’ve swiftly changed things to phone visits. We’re still open for urgent issues as we always take walk-ins and we want to help keep people out the ERs. We’re taking turns seeing the sick patients in clinic but otherwise people can work from home a couple days a week. Our whole mental health team went to working remotely.
I do wonder what the long term consequences of this will be in terms of pay/finances because clearly now we’re billing far less. A few months ago we had a meeting with the head of all our clinics and he said they typically have about 1 month of income in the bank, so could keep things afloat for 1 month if things got bad. So we’ll see what happens.
minzy yes it's not that we don't want to test people, the issue is we just don't have the number of tests needed! I posted an article in the news thread yesterday about the difference in S Korea and here and it made me even more angry at the thumb twiddling that went on from out government.
I work for Western PA's major hospital system, in outpatient psychiatry. I am amazed at how seriously my office has taken this- in under a week our office which sees hundreds of patients per day has gone almost entirely to televisits and plans to be completely remote next week. I would have never though it possible with the severity of patients we see and the groups we run, the amount of staff, the insurance reimbursement issues. Our management has really done an excellent job with this.
Yeah same here. We serve a highly underserved patient population with complex needs. But so far we’ve swiftly changed things to phone visits. We’re still open for urgent issues as we always take walk-ins and we want to help keep people out the ERs. We’re taking turns seeing the sick patients in clinic but otherwise people can work from home a couple days a week. Our whole mental health team went to working remotely.
I do wonder what the long term consequences of this will be in terms of pay/finances because clearly now we’re billing far less. A few months ago we had a meeting with the head of all our clinics and he said they typically have about 1 month of income in the bank, so could keep things afloat for 1 month if things got bad. So we’ll see what happens.
Right now our goal is to try to video visits as much as possible because many insurances have already allowed them to be billed at the same rate as in-person visits. Phone visits cannot be reimbursed as of right now, but there is a specific way we have to document so that hopefully we'll be able to go back and bill. (and regular outpatient already loses money every year due to the high number of no shows/low reimbursement through medicaid)
The only visits coming in to the office now are the new evals- pts who were at the ER and didn't meet the criteria for admission but need services. The goal is to get them to televisits next week.
Obviously it's too soon to see pt outcomes (a big part of the group model is just the act of getting out of the house and the social interaction that help in recovery) but pts have been really appreciative that we are doing this and are working with us to help with glitches and the learning curve.
Yeah same here. We serve a highly underserved patient population with complex needs. But so far we’ve swiftly changed things to phone visits. We’re still open for urgent issues as we always take walk-ins and we want to help keep people out the ERs. We’re taking turns seeing the sick patients in clinic but otherwise people can work from home a couple days a week. Our whole mental health team went to working remotely.
I do wonder what the long term consequences of this will be in terms of pay/finances because clearly now we’re billing far less. A few months ago we had a meeting with the head of all our clinics and he said they typically have about 1 month of income in the bank, so could keep things afloat for 1 month if things got bad. So we’ll see what happens.
Right now our goal is to try to video visits as much as possible because many insurances have already allowed them to be billed at the same rate as in-person visits. Phone visits cannot be reimbursed as of right now, but there is a specific way we have to document so that hopefully we'll be able to go back and bill. (and regular outpatient already loses money every year due to the high number of no shows/low reimbursement through medicaid)
The only visits coming in to the office now are the new evals- pts who were at the ER and didn't meet the criteria for admission but need services. The goal is to get them to televisits next week.
Obviously it's too soon to see pt outcomes (a big part of the group model is just the act of getting out of the house and the social interaction that help in recovery) but pts have been really appreciative that we are doing this and are working with us to help with glitches and the learning curve.
Thankfully last week our state medicaid said that phone visits can be reimbursed, it's much lower, but it's better than nothing. Hopefully your insurances get on board with that as well soon!
Yes and so far patients do seem to be taking it well and appreciative. We did have 1 person yelling and screaming at us in the waiting room yesterday :/ But everyone is extra stressed, so I guess somewhat understandable.
wesleycrusher , I also work in the outpatient department of a large psychiatric hospital and we are making similar changes. Unfortunately we're not fully up an running, so while my colleagues are having tele-sessions, I've been deployed to inpatient.
wesleycrusher , I also work in the outpatient department of a large psychiatric hospital and we are making similar changes. Unfortunately we're not fully up an running, so while my colleagues are having tele-sessions, I've been deployed to inpatient.
I'm shocked at how fast they have shifted the entire infrastructure of the clinic. I've never heard of staff moving between outpatient and inpatient in the past and it's not on the radar here now, but who knows what could happen.