General Principles
- All patients will be advised prior to their visits that they must wear
a mask at all times while in a Penn Medicine facility and if they do
not have a mask one will be provided.
- Patients will complete a COVID-19 questionnaire and undergo have their
temperature and oximetry documented in the electronic medical record.
All patients who qualify by Penn Medicine criteria will be instructed
to go for immediate testing. Patients that have a minimum of one
positive response on the questionnaire or an elevated temperature or
decreased oxygenation will be escorted to a designated COVID 19 clinic
room and be evaluated by a physician in consultation with infection
control. This minimizes risk of exposure and maximizes safety for both
patients and staff.
- Known COVID-19 positive patients or PUI who are asymptomatic from the
perspective of their Head and Neck Cancer should have follow-up visits
delayed until they test negative for Sars-CoV-2.
- During the surge leading up to and at the apogee of the COVID-19
incidence curve it is strongly encouraged that routine follow-up
visits or visits for treatment-related symptoms be done via telehealth
video visits whenever possible.
- During the surge leading up to and at the apogee of the COVID-19
disease curve suspicious symptoms or radiologic evidence of mucosal
disease should be assessed in the operating room under general
anesthesia in order to optimize control of potentially infectious
aerosolized secretions.
- Known COVID-19 positive patients, or PUI with new head and neck
symptoms that are potentially life threatening (e.g., bleeding,
shortness of breath) should be seen in the emergency room by staff
donning full protection, including PAPR.3
- Later in the COVID-19 disease curve when routine office visits have
resumed it is suggested that physicians wear N95 masks, goggles and
gloves routinely given their proximity to patients and the potential
exposure risks of aerosolizing procedures (e.g., fiberoptic
laryngoscopy, nasal endoscopy, tracheostomy change). Support staff
should not be in the patient examining room during aerosolizing
procedures and therefore should only require and wear standard masks,
goggles and gloves.21
- Anesthetizing the nasal cavity with spray systems prior to scoping
should be avoided until the COVID-19 pandemic is over.
- It is recommended that throughout the COVID-19 pandemic that all
outpatients have their temperature taken and have a COVID-19 history
taken before they are seen and that all patients with either elevated
temperatures or affirmative responses to the COVID-19 history be
escorted to designated COVID-19 clinic rooms for further evaluation by
providers and consultation with infection control for next steps.
- Each department will create a phased plan to incrementally increase
clinic volumes during this period with the goal of both avoiding
exposure of staff, physicians and other patients to COVID-19
positive patients and creating a waiting room environment conducive
with Social Distancing.