Follow-up to ED calls, May 12 and 13 – PPE, virtual care, and HR updates

This email was sent to EDs/Administrative Leads, Board Chairs and Lead Clinicians of AFHTO member organizations.

Thank you to all the executive directors who joined our third round of regional ED calls last week.

This email is a follow-up to provide the information promised during the calls, as well as other updates and supports, including a link to last week’s webinar with Maria McDonald, which you’ll find in the HR section below.

PPE

Question: What are the recommendations related to use of PPE with asymptomatic patients?

• The Chief Medical Officer of Health recommends that asymptomatic patients should first be screened over the phone prior to visiting the clinic. For non-COVID-19 related visits that are unavoidable, the patient should again be asked the COVID-19 screening questions upon arrival. If the patient screens negative to all questions and exhibits no signs or symptoms of COVID-19, the following is being recommended:   
  • At reception, if able to maintain spatial distance of at least 2 m or separation by physical barrier then no personal protective equipment (PPE) required by reception staff.  
  • Primary care providers should consider wearing procedural masks if within 2 m of a patient.  
  • Proceed with the patient as per Routine Practices, including hand hygiene and apply PPE as required based on the intervention. It’s suggested that a point-of-care risk assessment (PCRA) be performed by every health care worker before every patient interaction and additional PPE precautions be taken based on risk assessment.
• Check out the OH West PPE site for “Point of Care Risk Assessment – PPE Selection Guide” for guidance on precautions to take based on risk assessment.
• A one-page summary on the recommendations for asymptomatic patients and the “Point of Care Risk Assessment – PPE Selection Guide” is here.

Question: How can I access PPE?

• The ministry recommends the following pathway for accessing PPE:
  • Contact your regular supplier. They are your first point-of-contact and many suppliers have now increased stock.
  • If you’re unable to acquire PPE from your regular supplier, contact your OH regional table.
  • As a last resort, and if you have less than a 5-day supply, contact the Ministry Emergency Operations Centre (MEOC) at eocoperations.moh@ontario.ca
• The OMA SGFP has secured an arrangement for bulk purchasing of PPE with Surgo Surgical Supply – please connect with your affiliated physician group to get access to this information.
• The government’s Workplace PPE Supplier Directory also provides information on companies that sell PPE.
• With our primary care partners, AFHTO continues to advocate for a provincial approach to PPE bulk purchasing and centralized distribution.
• Guidance for PPE reprocessing is expected shortly. We will share this as soon as it is public.

Virtual care

• Kate Dewhirst of Kate Dewhirst Health Law has developed a number of virtual care policies that can be found on her website. The most recent policies and documents can be found on the bottom of her webpage.
• There have been some concerns about patients recording their appointments. AFHTO is discussing this with the OMA and CMPA and will provide feedback on how to mitigate this risk.
  • In 2017, CMPA posted about patients recording visits on their phone. The current response is that providers should be conducting every patient encounter as if they are being recorded.
• We are hearing increasing concerns about analog lines and rural accessibility to virtual care, including the challenge that not all patients have access to the internet or digital tools like computers and phones. We will continue to bring this to the attention of the ministry.
• Primary care teams have adapted to virtual care almost overnight and are leading patient-centric innovations in their community. Take a moment and learn more about what teams across the province are doing, and please share your initiatives with us at improve@afhto.ca.
• Teams are also starting to think about what aspects of virtual care they want to become standard in the new normal.
  • We encourage EDs to consider getting input from staff and patients about what recent changes they’d like to maintain. For example, North York FHT has recently done a Virtual Care Provider Experience Survey.
  • AFHTO is working with our primary care partners to roll out a provincial primary care patient survey and provider survey to measure the virtual care experience during the pandemic – stay tuned for more information on that!

Human Resources

• On May 14, AFHTO hosted an HR webinar with Maria McDonald of McDonald HR Law. The resources, including the webinar link, for “Managing HR and supporting staff through COVID-19” can be found here.
• The pandemic pay guidelines are expected soon. We hope to see primary care staff who are redeployed to high-risk areas, such as assessment centres, LTC homes, and hospitals, to be eligible to receive this pay.
  • Pandemic pay is an additional $4/hr from April 24 to August 13. An additional $250 monthly stipend applies to frontline staff working at least 40 hours a week in areas considered high risk.
• Teams can use the 10% exemption of payroll taxes to acknowledge staff efforts or recognize those whose responsibilities have increased. One-time bonuses or compensation increases are under the purview of each board, and COVID-specific policies would be needed.
• The PSHSA developed a document to help primary care organizations operate during the COVID-19 pandemic: “Health and Safety Guidance During COVID-19 For Physician and Primary Care Provider Employers.” The site also has a COVID-19 resource centre with tools and resources for employers and workers.
• The Ministry of Labour, Training and Skills Development has developed “Workplace Safety & Prevention Services Guidance on Health and Safety for Personal Services Settings during COVID-19.”

Canadian Family Physician (CFP), the journal of the College of Family Physicians of Canada, posted a blog by Dr. Kimberly Wintemute and Dr. Guylène Thériault on the “Post-COVID primary care reboot” that you may find of interest.

To capture the primary care experience, we will be reaching out soon to schedule interviews with executive directors, which we hope to start in early June. We ask you do your best to schedule one with us or to delegate to someone on the team who would be willing to be interviewed. We will hopefully be working with students at the University of Toronto to conduct these interviews, which will provide us with the narrative of how essential the role of team-based primary care was during the pandemic.

A reminder to keep checking out our COVID-19 section that we regularly update with news, tools, and resources, including the daily situation reports and regular memos from the ministry’s command table.

We’ll continue to keep you updated, and we’ll arrange another round of check-in calls to happen in about 2-3 weeks’ time.

Please contact us any time. We’re here to support you.

Sincerely,

Your AFHTO Team