Out-Patient Department Guidelines amid COVID-19 Pandemic

Objectives

  • Present OPD Guidelines amid COVID 19 Pandemic
  • Begin OPD operations utilizing the Hospital Ancillary Services
  • Start the OPD Clinic operations and consultations of Doctors utilizing the improvised OPD Clinics located at 3rd floor (View deck) with free flowing air ventilation (Tent) or the Regular Clinic Rooms.
  • Maintain safety and preventive measures against COVID-19 for all Doctors, OPD Personnel, Patients and visitors / relatives.

Scope

These guidelines cover the utilization of the following areas:

  1. OPD Dialysis Units 2nd & 7th Floors.
  2. Improvised Clinics (Tents) in the 3rd Floor and Regular Clinic Rooms in the 4th Floor.
  3. Ancillary Services (Radiology, Laboratory Medicine & Multi-Specialty Clinic etc.)
  4. Ambulatory Clinic (ENT, Oncology, Hematology & Rheumatology)

Physical Structure

  1. Holding Area One (1) – Hospital Driveway

    Serves as the Initial Waiting Area for all patients entering the hospital except for emergency cases.

    The following shall be accommodated:

    • Patients for OPD Consultation
    • Dialysis patients
    • Ambulatory patients
    • Patients for OPD Diagnostics and Laboratory Examinations
    • Suppliers and Collectors
    • Patient’s Visitors/Relatives

    Note: Entry point: Glass door (Besides the Industrial & Occupational Medicine Office)

  2. Triage Area One (1) – Hospital Ground Floor (Glass Door)

    Initial screening shall be conducted by the designated person or the Triaging Officer/Resident on Duty by:

    Screening for COVID-19 and other related cases:

    • Taking of temperature and necessary vital signs
    • Filling out of the Screening form and other history taking materials
    • Clearance from the Triage Area One (1) shall be given to all patients that will be referred to Triage Two (2) for further screening, processing of documents and consultation.
    • The signed Clearance Form shall serve as the entry pass to the following areas:
      • Triaging Area Two (2) (3rd floor Auditorium or 4th Floor Regular Clinics)
      • Dialysis Units 2nd & 7th floor
      • Ancillary Services
      • Ambulatory Unit
      • Other support areas with direct patient interactions (Medical Records, PT-Rehab, Pharmacy, CSR etc.)
    • For suspected COVID-19 patients, referral to Emergency Room shall be conducted and DOH recommended algorithm shall be applied.

    Note: Radio Communication shall be used for proper channeling of patients from one triage area to another.

  3. Triage Area Two (2)
    1. 3rd Floor Physical Therapy & Rehabilitation Medicine (Glass Window)
    2. Dialysis Units - 2nd & 7th floor
    3. Ancillary Services - Ground floor
    4. Ambulatory Unit – 3rd floor

    The following activities are conducted here:

    • Registration of all patients to Hospital Information System
    • Verification of clearance form for its completeness.
    • Processing and approval of all HMO’s and other Guaranteed Letters (GL)

    Note: HMO & Guaranteed Letter (GL) from PCSO and DSWD shall be processed prior to the consultation and performance of Ancillary Services.

  4. Holding Area Two (2)
    1. 3rd Floor Hospital Auditorium – Patients for OPD Consultation
    2. 7th Floor Dialysis – vacant space in the 7th Floor
    3. Designated areas - Ancillary Services
      • The above areas shall serve as the final waiting area for all patients
      • Educational Video Presentation or Hospital Promotional Advertisements shall be played as part of the hospital’s health teaching and marketing.
      • Countersigning by the respective personnel shall serve as a clearance before leaving the area.
      • The signed clearance form shall be presented to the Security Guard on duty before leaving the hospital premises.
  5. OPD Clinics
    1. Improvised Clinics (Tent)
      • Area for the consultation of patients provided with tables, chairs, and other materials in the clinic.
      • Structurally prepared for consultation with partition between Doctors and Patients
    2. Regular Clinic Rooms
      • Area for the consultation process
  6. Donning and Doffing Areas

    Separate areas for wearing and disposing of PPEs

OPD Guidelines

  1. General Guidelines
    • There is a separate pathway for the Doctors and Patients/Relatives. A color coding scheme is developed for implementation. Red Sticker for Doctors and employees while Green Sticker for Patients going to 3rd Floor and 4th Floor.
    • The new elevator located near the Emergency Room is dedicated for transport of COVID-19 patients and PUI while the old elevator is used for clean or non-infected cases.
    • Proper utilization and disposal of PPEs are followed in the Donning and Doffing Areas. A person is available to help the HCWs in the areas.
    • There are no changes in the schedule of Doctors in the IMPROVISED and Regular OPD Clinics unless/otherwise there are adjustments.
    • Schedule of patient’s appointment is arranged and limited to the allowable number based on the required capacity in compliance with the Physical Distancing.
  2. Doctors / Personnel
    • All HCWs follow the Red Sticker attached in the floor area to comply with the directional signages of going In/Out of the premises.
    • All Doctors and secretaries are provided with complete set of PPE (one time issuance) FREE OF CHARGE. Proper donning and doffing techniques and disposal are observed.
    • All Doctors are encouraged to practice the infection prevention and control set by Department of Health and Center for Disease Control during the clinic schedule to avoid unnecessary transmission. These are the following but not limited to:
      • Proper hand hygiene procedure before and after consultation of patient/s.
      • Disinfection of medical equipment and the entire clinic
    • All Doctors are encouraged to lessen the exposure to all consulted patients for safety purposes without compromising the care needed by the patients.
  3. Patients
    • All Patients are screened in the TRIAGE AREAS to be processed and designated in the two (2) locations allocated as Holding or Waiting Area.
    • All Patients are required and charged to have a face mask, gloves and sanitizing agent before entering the hospital premises after clearance from the TRIAGE ONE (1) AREA at the Ground Floor Lobby.
    • All Patients can be accompanied by one person/relative only likewise with proper PPE (same as the patient). This practice is extended if the patient in the OPD is admitted.
    • All SCREENED PATIENTS are guided by the TRAFFIC FLOW through the Green Sticker from Ground Floor to 3rd Floor Auditorium or 4th Floor Regular OPD.
    • All the SCREENED PATIENTS utilize one (1) elevator only or the staircase beside the elevator in going up to the Auditorium or 4th Floor OPD.
    • All SCREENED PATIENTS are directly referred to the TRIAGE TWO (2) AREA such as designated location for Ancillary Services, in front of the PT-Rehab Area before entering the Auditorium and in the 4th Floor Regular OPD.
    • The SCREENED PATIENTS enter the Auditorium or 4th Floor OPD Hallway following the required PHYSICAL DISTANCING of the chairs provided to each patient.
    • Assigned Secretary of the IMPROVISED/REGULAR CLINICS shall call the patient/s based on availability of Private/Decked Doctors.
    • After Consultation, the patient is guided based on the order/s from the Doctor/s.
      • With MGH Order
      • With Diagnostic and Laboratory Procedures
      • With Direct Admission / ER Admission

Forms and Promotional Videos

  1. Triage Form
  2. PPE Checklist
  3. Ancillary Instruction Form
  4. Signage (Directional, PPE)
    • Social Distancing
  5. COVID – 19 Video Advertisement

Materials Needed

  1. Tables and Chairs
  2. Office Supplies and Forms
  3. Medical Equipment and Accessories (Commonly used in the OPD)
  4. Trash bin (Non-Infectious and Infectious Waste)
  5. Alcohol and Zonrox (Spray Gun)
  6. Complete Set of PPE
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