COVID-19 (CORONAVIRUS) UPDATES

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Re-Establishment of Services Frequently Asked Questions

Are the affiliates of North Country Healthcare (NCH) re-establishing services?
Yes. Androscoggin Valley Hospital, North Country Home Health & Hospice Agency, Upper Connecticut Valley Hospital, and Weeks Medical Center will use a phased approach to ensure patient, provider and employee safety, based on national, state, and regional guidelines and recommendations.
For the past several weeks, many departments have continued to provide care, whether in person or via telehealth, as appropriate. During that time, appropriate steps have been taken to best ensure the safety and well-being of our patients and staff.

What are the phases?
Phase 1:
Patients whose care was postponed due to the COVID-19 pandemic will be assessed by our healthcare providers to best determine the urgency and proper timing of treatment. Many patients actually continued care remotely via telehealth services from within their respective home. All patients who can continue to be seen via telehealth will be encouraged to continue that mode of treatment unless the primary healthcare provider recommends otherwise. The North Country Home Health & Hospice Agency team will be available to provide care to high-risk patients. Services, including COVID-19 testing, as appropriate, will be provided in a patient’s home.

What are the guidelines for Phase 1?
• Centers for Disease Control (CDC), State and Federal guidelines will be monitored and followed throughout all phases
• Staff will continue to be screened daily (including temperatures) before beginning work
• Reminder calls for appointments will be conducted for new patients to assess risks/concerns of COVID-19. Questions regarding patient symptoms, recent travel, contact with any individuals infected or potentially infected, will be asked.
• Patients will be screened at their vehicle, as able or at the facility entrance at the time of arrival. Questions regarding COVID-19 symptoms (fever, chills, body aches, loss of taste/smell, etc.) will be asked.
• Handwashing/hand sanitizing of patients and staff will continue to be emphasized upon arrival and discharge. Hand sanitizer will be available at facility entrances.
• Exam rooms and equipment will be sanitized after patient visits
• Lobbies will be appropriately cleaned regularly
• Social distancing will be promoted by signs and markers within member hospitals
• No waiting area will be open, unless absolutely necessary. If used, the area will be cleaned after each patient visit
• Patient appointments will be staggered to reduce patient interaction
• Patients will be brought to the exam room immediately, as able
• No paperwork will be completed at the reception desk unless it is determined to be necessary
• Use of the affiliate’s Patient Portal will be encouraged
• Appropriate COVID-19 testing will continue to be conducted, as supplies allow and CDC guidelines recommend
• No visitors will be allowed at NCH hospitals, unless in rare exceptions (one support person for labor/delivery (Androscoggin Valley Hospital); a caregiver is necessary for care (all facilities); end-of-life care (all facilities)
• Verbal and online communication will continue to keep patients, providers and staff updated with changes
• Time-sensitive procedures will resume on a staggered schedule, ensuring surgical patients do not recover in the same area at the same time
• Masks will be worn by all patients, providers, nurses and staff
• Pre-registration and verbal consents will be encouraged. Reception areas will feature clear, visual markings to indicate six-foot spacing.

Phase 2:
In phase 2, there will be a reduction of the assignment of patient urgency as patients begin to see their respective primary care provider for more routine care. The type and number of surgical procedures will continue to increase, as consistent with CDC and other recognized guidelines and the continued availability of personal protective equipment. Many telehealth visits will transition to in-person visits within the hospital or home (North Country Home Health & Hospice Agency), while social distancing and the wearing of masks will continue.

What are the guidelines for Phase 2?
• CDC, State and Federal guidelines will be monitored in making care decisions
• Staff will continue to be screened daily (including temperature) before beginning work
• Time-sensitive procedures, including total joint replacements (provided a spinal anesthetic can be administered) will resume on a staggered schedule, ensuring surgical patients do not recover in the same area at the same time
• Reminder calls for appointments will be conducted for new patients to assess risks/concerns of COVID-19. Questions regarding patient symptoms, recent travel, contact with any individuals infected/potentially infected, will be asked.
• Handwashing/hand sanitizing of patients and staff will continue to be emphasized upon arrival and discharge. Hand sanitizer will be available at all entrances.
• Exam rooms and equipment will be sanitized after patient visits
• Use of the affiliate’s Patient Portal will be encouraged
• Appropriate COVID-19 testing will continue to be conducted, as supplies allow and CDC guidelines recommend
• Use of the waiting area can expand, with physical distancing guidelines in place (chairs six feet apart, etc.)
• Masks will be worn by all patients, providers, nurses and staff
• Phone registration will remain encouraged
• Select previously-suspended services can resume

Phase 3:
In phase 3, the majority of patients can be seen at an NCH-member hospital or in the patient’s home (North Country Home Health & Hospice Agency). Elective surgeries may resume, as long as there are adequate resources (personal protective equipment (PPE), staff, etc.) Patient appointment restrictions will continue to be removed. Telehealth needs will continue to be assessed.
What are the guidelines for Phase 3?
• CDC, State and Federal guidelines will be monitored in making care decisions
• Staff will continue to be screened daily before beginning work
• Reminder calls for appointments will be conducted to assess risks/concerns of COVID-19. Questions regarding patient symptoms, recent travel, contact with any individuals infected/potentially infected, will be asked.
• Handwashing/hand sanitizing of patients and staff will continue to be emphasized upon arrival and discharge. Hand sanitizer will be available at all entrances.
• Exam rooms and equipment will be sanitized after patient visits
• Use of the affiliate’s Patient Portal will be encouraged
• Appropriate COVID-19 testing will continue to be conducted, as supplies allow and CDC guidelines recommend
• The assessment of patient urgency may return to pre- COVID-19 standards
Why are you using a phased-in approach to establish services?
• The phased approach closely parallels national and state guidance.
• The phased approach will help us continue to monitor our levels of personal protective equipment (PPE) for staff.
• The phased approach will help us monitor the health and number of staff available as we increase the amount and level of care to our communities.
• The phased approach will help us monitor the testing process and capabilities (regionally, statewide and nationally), ensuring that we remain aligned with CDC guidelines.
• The phased approach will help us monitor hospitalizations and our ability to effectively care for our populations in the most appropriate manner.

What is the timeframe for each phase?
There will be approximately two weeks between phases.
Phase 1: Beginning Monday, May 11, 2020
Phase 2: Beginning Monday, May 25, 2020
Phase 3: Beginning Monday, June 8, 2020

It is important to note that the guidelines are flexible and will be changed, as necessary, to best ensure patient safety due to any changes in treatment/testing recommendations, available resources, and patient volume.

Where are you getting the guidance for the re-establishment of services?
In addition to NCH and affiliate member task forces, we have received and continue to receive guidance from the Centers for Disease Control, New Hampshire Hospital Association, our Chief Medical Officers and facility Presidents, NCH and affiliate Incident Command Center members, and NH Governor Sununu’s Task Force.

What precautions are you taking to ensure the safety of patients and staff?
• Patients and staff will wear masks throughout phases 1 and 2. Future recommendations and guidelines will be assessed for appropriate masking decisions for phase 3.
• Personal protective equipment (masks, gloves, gowns, eyewear) will be used, as deemed appropriate by CDC guidelines
• Proper hand hygiene (including hand sanitizer available at our entrances) by patients, providers, and staff will continue
• Adherence to CDC guidelines for COVID-19 testing will continue
• Patient flow is being modified to most efficiently route patients
• Patients will be screened during pre-appointment calls
• The care of patients with COVID-19 symptoms will be consistent with CDC guidelines
Please note that our hospital Emergency Departments have continued and will continue to be open 24 hours/day, seven days a week. If you are experiencing a medical emergency, please proceed to your local Emergency Department as soon as you start to have symptoms, as delaying care can be detrimental to your health. Infectious patients have always been and will continue to be separated from others.

Do you have enough personal protective equipment to ensure safety?
Yes. All NCH affiliates monitor their supply of PPE several times per week. Supply quantity is communicated amongst our affiliates frequently. It is important to note that should the supply unexpectedly be of concern, the next phase in the re-establishment of services will be delayed to best ensure the safety of our patients, providers, and staff.

What should I bring to my appointment?
We encourage you to bring only that which is essential. This may include a list of your medications, your insurance card, and, if appropriate, your cellphone. Personal handbags, etc., should not be brought to the facility.

What do I do when I arrive for my appointment at a hospital or off-site clinic?
Prior to your appointment, you will receive a reminder call for the first appointment to the department, informing you of actions to be taken.
During Phase 1: If you arrive at the facility, have a cellphone and can wait in the vehicle, please call the department directly when you arrive for further instructions. If you can not wait in a vehicle at the facility and call the department directly, please enter the building and inform the employee conducting the screening that the department does not know that you have arrived.
During Phases 2 and 3: Traditional registration at the applicable registration area can resume, though telephone registration, as available, will be encouraged.

What if I need care but am at high-risk and am sheltering in place?
The North Country Home Health & Hospice Agency team is available to provide care to high-risk patients. Services, including COVID-19 testing, as appropriate, can be provided in a patient’s home. They can be contacted at (603) 444-5317.

When I visit my healthcare provider, does it mean that I will automatically be tested for COVID-19?
Androscoggin Valley Hospital, North Country Home Health & Hospice Agency, Upper Connecticut Valley Hospital, and Weeks Medical Center will continue to follow CDC guidelines pertaining to testing recommendations.
The New Hampshire National Guard has established a testing site in Lancaster. There, tests are administered eight hours per day, seven days per week, with a doctor’s order.

Where can I view the CDC guidelines to learn more about COVID-19?
Please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html