Editor’s note:AAP interim guidance is based on current evidence and best data at the time of publication. Updates are provided to reflect changes in knowledge about the impact of the disease on children and adolescents.For the latest news on COVID-19, visithttps://www.aappublications.org/news/2020/01/28/coronavirus.
The AAP is emphasizing the importance of the medical home as well as community partnerships as pediatricians care for acutely ill children during the COVID-19 pandemic.
“Every patient/family request must be viewed through a family-centered lens that is cost-effective, enhances the patient care experience for individuals, and improves the quality of care and health of populations,” according to the interim guidance “Caring for Children With Acute Illness in the Ambulatory Care Setting During the Public Health Emergency.”
To conduct visits safely, practices should enforce social distancing, universal face coverings and hand hygiene for all patients and their families. Health care workers should wear appropriate personal protective equipment (PPE), facilities should be carefully cleaned and disinfected, and practices should find creative alternatives to crowded waiting rooms.
Instead of self-scheduling and walk-in appointments, practices should consider nurse triage conversations via phone or secure chat. These conversations can be used to determine whether a patient needs advice for home care, a telehealth visit, an in-person visit or referral to a partner in the medical neighborhood.
Practices should pay special attention to children who have had a fever for three or more days to assess for signs of multisystem inflammatory syndrome in children (MIS-C). Children with potential MIS-C will need additional assessment and consultation with specialists.
Telemedicine can be a powerful tool for initial patient evaluation and acute care for many conditions. It can help with timely access to care and provide a safe alternative for those uncomfortable with in-person visits. Telemedicine also can be used to screen patients with respiratory illness and determine whether additional testing is needed for COVID-19, flu or other illnesses. Clinicians’ first step should be to ascertain whether the patient is ill enough to need further assessment or intervention in person.
The AAP recommends working with community partners like schools, child care centers and public health resources to help children access care they need. Pediatricians also can form referral relationships with other local practices and health care systems. Acute care partners such as urgent care centers, testing centers and emergency departments can be valuable but also have limitations. It is important to promote the use of community partners that communicate with the medical home.
“In summary, providing appropriate access to high quality, safe, timely, and cost-effective care to all pediatric patients will be challenging during the COVID-19 pandemic but is achievable if communities work together to provide a coordinated medical home neighborhood/regional network,” the AAP’s guidance says.
New guidance on interfacility transport
The AAP also released new guidance on interfacility transport of patients who have suspected or confirmed COVID-19 that includes discussions of screening, precautions, PPE, cleaning and supporting families.