What unique opportunities/challenges does your office set-up, patient population, etc...present that affect how you provide care during the pandemic?

You decide to do a “car visit”. You are fortunate that your clinic has an easily accessible parking lot with a small area you have blocked off for the purpose of seeing patients like this outside of the clinic when possible. You instruct the parent to call and inform your staff they have arrived. You put on the appropriate PPE in anticipation of collecting a specimen for COVID testing. You have recently reviewed this information from the CDC so you know how to do this correctly. You have also recently reviewed this resource which provides some more helpful information from the AAP.

You ask the mom to give her son 2 puffs of his albuterol with a spacer and mask prior to driving over, and you request the mom bring the albuterol and spacer and mask with her to the appointment. You also request they bring their face masks. The mom has some questions about  whether her son really needs a mask so you send her this resource to review.

When they have arrived, you begin the visit with the patient sitting in the car on his mom’s lap. You are able to obtain a specimen for COVID PCR testing. You are also happy to see that your patient’s work of breathing is somewhat improved after the albuterol treatment mom administered at home. You do feel you need to have him do a second treatment and you want to monitor him for a bit but it is just starting to rain so you decide he needs to come into the clinic. Fortunately, his mom has brought their masks and your patient’s respiratory status is stable enough that you believe he will be ok wearing the mask to walk through the front of the clinic. You have him come directly into the exam room to minimize exposure to others. You have previously consulted with your facility’s management and you have reviewed the CDC document regarding air exchanges per hour requirements so you feel confident that you have done what you can to ensure reasonable ventilation in the clinic rooms. You also have a HEPA filter in the exam room.

Since the pandemic began, your clinic has been bringing all patients back promptly to exam rooms where paperwork, vital signs and other pre-visit tasks can be completed away from shared spaces.

Your asthmatic patient has been brought to the designated “sick” area of the clinic. Fortunately it is late in the day, so he will likely be the last patient in this exam room. You want to limit staff exposure so you complete the gathering of vital signs yourself, and you are the only individual that enters the exam room.

How would you do this visit differently at your office?

Your patient eventually improves enough that you are comfortable sending him home on an appropriate medication regimen and plan a follow-up by telemedicine visit the following day. You also review with the mom CDC recommendations for isolation and quarantine,  and you provide this pictorial education handout. You inform the family you will call them with PCR results when they become available.