• Dr. Amit Gosalia

So, We are Opening Back Up... Now What?!

(Disclaimer: All information presented in this posting should be confirmed by your local health authorities, is not all-inclusive, and is not legal advice. Additionally, new information continues to be provided by the CDC, WHO, OSHA and local health authorities. Information presented is as of May 3rd, 2020)

On December 31st, 2019, dozens of people in China were treated for a pneumonia with unknown cause. Two weeks later China reported their first death. As the virus, and its lore, spread, by March 15th, 2020, the Centers for Disease Control (CDC) recommended no gatherings of 50 or more people within the United States. This was followed by restrictions to businesses to shutter nation-wide except for ‘essential workers’ which included, but not limited to, grocery store employees, first responders, healthcare workers...however, audiologists were not specifically named in the list of healthcare workers. The profession of audiology was muddled…Hearing is essential for communication, however, audiology does not provide life-sustaining services. Some audiologists reached out to our city’s mayors offices, they considered audiologists ‘essential’ workers, however, our national organization, the American Academy of Audiology deemed us ‘non-essential’ and recommended that we close our doors, on March 22nd, 2020. Many practices closed completely, some stayed open for drop-off/curb-side service, and some even stayed fully open throughout the ‘stay at home’ orders…

In late April 2020, many cities began lifting some of their restrictions allowing some businesses to reopen. Thus, many audiologists decided to get back to our clinics, to help serve the public who may have been suffering through their own quarantines. But, now that we’ve gone back and opened our doors, what now?

Yesterday, Monday May 4th, marked the first day back to the clinic, and processes and protocols are different, they must be. We've added signs on our door (CDC, etc) along with a City of LA sign that is required. Every patient that comes in MUST go straight to wash their hands, get their temps taken, wear a mask and are handed a pair of gloves. It's not easy nor is it convenient. The relationship factor and facial cues are hampered. It's no longer fun, but, it is what's required. Here are the points that must be taken into account when returning to your businesses.


Note: This list is not all-inclusive and local authorities may require more or less stringent requirements.





PROTECTION

The primary objective MUST be the safety of our patients, our staff and of course, us! There is no single answer, however, precautions MUST be taken. We cannot be too safe. Since the CDC and OSHA state that most American workers will likely experience low or medium

exposure risk levels at their job or place of employment (www.cdc.gov). For many of us, our patient demographics are predominantly 65+ years of age. I have categorized the main parties who may be affected.

Note: Infection control information can be found on Dr. AU Bankaitis-Smith's blog: http://aubankaitis.com/Audiology/infection-control/

Patients – We may consider limiting the number of patients in your offices as well as limiting the number of family members/caregivers in the office. When they come in, they MUST wear a mask covering their mouth and nose. The mask must stay on during the entirety of their presence in our offices. They may wear gloves and may use a face shield.

- Some clinics have opted to only allow 1 patient in the office (per provider) at a time.

- Some clinics have opted to have patients wait outside, until called in

- Some clinics have continued to only use curbside for hearing aid/supply related appointments

- Some clinics have instituted a 6-foot distance between chairs in their waiting rooms

Patients should not be in our office if they display symptoms such as

- dry cough

- shortness of breath

- fever

- muscle pain

- chills

- headaches

- sore throat

- loss of taste/smell

(NOTE: this list is not inclusive and should be cross-checked with the CDC and/or your local health authorities)

Staff – MUST wear masks throughout the day. Masks should be changed or washed daily.

If staff are touching patients or their devices, they must use gloves, which should be discarded after use.

Staff should wipe down their work areas daily with approved wipes (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html). Staff should also wipe down any surfaces that a patient may have touched, including door handles, counters, clipboards, restroom keys, desks, chairs, etc.

If staff display above-mentioned symptoms, they MUST notify their supervisors/employer and either stay home and/or be asked to go home. Employees who are sick should follow the CDC’s recommended steps (https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html). Employees should NOT return to work until home isolation criteria are met. It is required that emplyers alert other employees that an employee showed the above-mentioned signs, however, per Americans with Disabilities Act (ADA), their identity must remain confidential.

(NOTE: please confirm with your local health authorities for appropriate actions)

Providers – MUST wear masks throughout the day. Providers may consider using masks with clear windows to allow hard of hearing patients the ability utilize visual cues (i.e. lipreading).

While within 6 feet of a patient, provider must use an approved face-shield that extends from cheek to cheek. Those shields must be wiped down after each patient. The face-shield MAY be used in lieu of a mask, however, better to be safer and use both.

If providers are touching patients or their devices, they must use gloves, which should be discarded after use.

Providers should also be proactive and wipe down their work areas, audiometers, impedance bridges, medical instruments (i.e. otoscope handle, etc), daily with approved wipes.

Scrubs, aprons or lab coats are another layer of protection, but are not necessary…but, clean clothes are necessary.

Students – MUST follow above provider guidelines and/or their school/program’s guidelines.

Delivery people/Visitors – MUST be asked to wear a mask and gloves prior to entering the offices. If they display the above-mentioned symptoms, ask them not to enter.

*Everyone must wash their hands with soap for 20 seconds with warm/hot water multiple times a day.

COMMUNICATION

Alerting your patients and referral sources that you are open will be key to your continued success. Consider alerting your current database via (use multiple if needed):

- Emails

- Notice on website

- Social media posts

- Phone calls

- Letters/Direct mail

- Publication advertisements

The most effective way would be to email your whole database. The cost? Essentially, nothing. However, the phrase “garbage in, garbage out” could be applied here! If your staff have not been collecting email addresses from your patients, this isn’t the most effective option.

Another cost-saving announcement would be to post your announcement on your social media accounts and websites, however, patients have to be following your sites to notice it, and even then, they may miss it.

A less effective way is to call all of your patients. Clinics with thousands of active patients would frown upon this idea. However, perhaps a good idea to reach out to recent hearing aid fittings, consults or patients who recently had procedures or adjustments done.

Less efficient and most costly is paid advertising. Refrain from the idea that your competitors may have closed their doors permanently, and this is your opportunity to capture that market. Focus on getting your business back to shape first, then focus outwardly.

The most effective way to communicate with your referral sources is to call them or send them a short note. Many physicians have some free time since their patients are currently not scheduling appointments. Give them a ring and nourish that relationship.

EXPECTATIONS

Business will be slow. Patients will continue to stay home or won’t be allowed to leave home. People are concerned about the economy, their health and their finances.

However, there may be a spike in patients who have struggled with their hearing ability during their quarantines! Be prepared to help these folks. If you don’t feel safe, don’t do certain procedures, i.e. cerumen removal, earmold impressions, etc.

Staff and/or providers may not feel comfortable coming to work and you should allow for ‘sick leave’, furlough or lay them off. That’s a business decision you must contend with, one you are comfortable with.

Your normal deliveries may be delayed, including hearing aid equipment and supplies. Reports of personal protective equipment (PPE) delays are rampant.

‘Control the controllables’ is all we can do. We must control what’s happening within our businesses no matter what is happening outside of our businesses. External forces will always continue to impact our businesses. Focus on our four-wall!

Be patient. If you are aware of the potential above-mentioned issues, then you’ll be fine.

LEADERSHIP

‘Tough times don’t last, tough people do’. Our job is to provide a work environment that is safe and to relay the message that we will be okay. As leaders it is our job to be team players and understand the needs of our staff and patients. Be confident in your responses, be sure you are ready to open your businesses, and don’t be shy to ask other for help. Our staff/teams are as concerned as we are about the future and may not have access to the same amount of information that we do. Be there for them. Answer all of their questions and if you don’t know the answer, don’t ‘fake it till you make it’, be honest and let them know you will get them an answer. Be prepared for some tough questions and even some perceived simple questions. Don’t belittle or condescend them. Be the leader.

*

No matter how long it takes, this will pass and there will be a new normal. If we follow the appropriate guidelines, protect ourselves, communicate with our staff and patients, set appropriate expectations and lead our teams, our businesses will survive! If you have any doubts, questions and/or comments please message me at heardr@gmail.com. Be safe, stay positive and best of luck!

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© 2020 Dr. Amit Gosalia

Amit Gosalia, AuD

heardr@gmail.com

(602) 625-7655

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