How Has the COVID-19 Pandemic Affected Your Practice? - Clinical Advisor

How Has the COVID-19 Pandemic Affected Your Practice?

Slideshow

  • Slide

  • Location of respondents based on region.

  • Figure 1. Percentage of respondents who have or have not treated patients with COVID-19.

  • Figure 2. Number of patients seen with COVID-19.

  • Figure 3. Percentage of providers who have been diagnosed with SARS-CoV-2.

  • Figure 4. Percentage of responders who feel that their workplace has sufficient or insufficient PPE.

  • Figure 5. Percentage of participants whose practice has switched to telehealth due to the COVID-19 pandemic.

The Clinical Advisor conducted an audience survey in early April 2020 to gain insight into how the current novel coronavirus (COVID-19) has affected their clinical practice. We heard from 543 nurse practitioners (NPs) and physician assistants (PAs) from across the country, some who are experiencing the pandemic firsthand and others who are bracing for the storm to come. Here is a sampling of the comments (edited for space) describing experiences on the frontlines of care, on transitioning to telemedicine, and on being furloughed.

On the Frontlines:

New York, NY: It has been a war zone. I work in the catheterization laboratory, which turned into a full COVID-19 unit with ventilated patients fighting for their lives. We are all learning as a team but inevitably people do die and their families are not allowed to be by their side.

Boston, MA: I am a PA hospitalist and our schedules and roles have been ever changing since COVID-19 hit the United States. I have served as a direct care provider to COVID-19 patients, as well as taught PAs from other specialties how to care for them. I come to work uncertain of where I will be stationed and uncertain of how/when my patients will deteriorate. This virus is completely nondiscriminatory; perfectly healthy patients in their 30s have deteriorated quickly. When I am not at the hospital, I spend the bulk of my time trying to figure out how I can best help my colleagues who are working (prepping notes, medication reviews, etc). I feel overwhelmed by the need to do more, yet fearful I won’t be good in the new role that I am placed in.

New York, NY: Life has taken a 360-degree turn since COVID-19 hit New York City. [Our urology] practice is covering for multiple providers as they are reassigned to hospitals, emergency departments (ED), and intensive care units. We are trying to prevent patients from going to EDs, thereby decreasing burden of overload. My [urology] NP colleagues who are in the hospital running COVID-19 floors were not given any training and/or orientation except for online electronic health record [EHR] documentation training. I am nervous about my turn, but I will do my best to provide the best care for the patients and their families. I never expected this level of unpreparedness in a country like the United States, and I believe this COVID-19 crisis has taught us all valuable lessons in infection control and disease prevention.

Southfield, MI: Don’t miss the atypical presentations. I have had a COVID-positive patient that presented with vomiting and a small amount of diarrhea, another patient that presented with headaches, and another with runny nose. All of these patients were working and were unknowingly exposing others to the illness; no one has mentioned these atypical presentations.

Salem, OR: Out of our staff of 60, 11 clinicians have tested positive for COVID-19 and 6 have suspected cases. We had to close our office for 2 weeks, and just reopened yesterday [April 14, 2020]. During those 2 weeks, the physicians took calls, either via phone calls or telemedicine. Getting test kits and testing our staff has been a problem;  1 week we only had 8 COVID tests and had to decide who the highest priority was and then wait as long as 13 days for the results. Three weeks ago we ordered 50 of the new antibody tests by Lochness Medical. Today we learned that US Customs has held the tests at the border.

Telemedicine Challenges

Southfield, MI: Masks and glove supply depleted by mid-March so moved to telehealth.

Yukon, OR: We started by trying to isolate the office, screening patients by phone before they entered the building, and keeping the clinic “clean.” We encouraged but did not insist on telemedicine appointments. When it became clear that there are many asymptomatic people who are spreading disease, I chose to completely convert to telemedicine. Much of the office has now done the same. So far, most of my scheduled patients are just cancelling and waiting to reschedule until restrictions are lifted.

St. Louis, MO: Switching to telehealth and virtual visits has been a huge learning event for us. There were so many details that were being worked out on an hourly basis. I found, through experience, that my virtual visits were of much shorter duration and ran on time. Nearly every patient has been positive regarding the virtual visits and appreciate it as an option.

Three Rivers, MI: In transitioning almost completely to virtual office visits we’ve really streamlined the way we provide healthcare. I’ve noticed from the administration down, the ever-present “bottom line” has taken a backseat in our outpatient practices, and we are providing the type of patient-centered, innovative, accessible medicine that we wish could always be our sole focus. Out of this horrific tragedy, we are making enormous strides in just a few days that would have taken years to change in any other reality — to adapt, provide the best possible care to our clients, and survive as a health system.

Furloughed

Dallas, TX: It has been economically devastating. We have had to reduce staff hours by 75%. Relatively few cases in Dallas. The hospital and clinics are nearly empty awaiting a flood of COVID-19 patients that don’t appear to be coming. Obviously a good thing but hard to comprehend how we get stared again. Really need a quick test to screen all hospital admissions to protect patient and staff safety.

Fayetteville, GA: With no elective surgeries allowed and seeing only urgent/emergent orthopedic patients in the office, most of the advanced practice providers have been furloughed or let go. I am the most senior PA in my office and was the first furloughed. Also, many of the other clinical and administrative staff have been furloughed or let go. Those still working have taken a 20% pay cut and had hours reduced. I have learned that we need to be better prepared.

New York, NY: We have cancelled well visits for 18-month-old and older children. We provide telephone visits, no video. The clinic will need funding to survive. We have nurses and staff hanging out with nothing to do; only the doctors and NPs continue to work with the telehealth visits.

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