If a patient presents with symptoms of Ebola—which can include fever, headaches, weakness, vomiting and diarrhea—and has traveled to West Africa or had contact with an Ebola patient in the last 21 days, the CDC tells providers to isolate the patient in a single room with a private bathroom and with any door to a hallway closed.
If a patient presents with symptoms at a clinic's front desk, they should be placed in the nearest room possible, said Julie Loomis, assistant vice president of risk management at State Volunteer Mutual Insurance Co. For many offices, that could be a bathroom attached to or near the waiting room area, she pointed out.
“You don't want them to have to go very far and transmit to others,” Loomis said. “If you have to walk them from where they are to an isolation room, you're going to expose other people and surfaces.”
Loomis, who is a registered nurse and has a law degree, said it is especially important that all medical offices purchase CDC-recommended personal protection equipment for every staffer who could possibly come into direct contact with patients, from the front desk to the back office. Most non-emergency clinics currently do not have personal protection equipment, and if they do, they often don't have enough for every staff member, she said.
Staff at the Harvard Vanguard office told the patient there to return to his car and wait until first responders arrived. When asked whether clinics should consider screening patients at the front door before they enter the waiting room, Loomis said such a practice would create too much unnecessary panic. Other experts agreed, saying such a move could violate providers' legal and medical obligations if they turn away a patient who has a serious condition that is not Ebola.
Ultimately, patients should be told not to come to a doctors' office if they think they might have Ebola, Loomis said. As an extra precaution, Loomis pointed out that staff could screen patients when they call to make an appointment, to ensure that they haven't traveled to the affected region.
Urgent-care clinics are generally more prepared than the average doctors' office, according to Dr. William Gluckman, owner of FastER Urgent Care in Morris Plains, N.J., and a member of the Urgent Care Association of America's board of directors. Most urgent-care clinics have personal protection equipment on hand. UCA is planning to send out information to its members regarding the appropriate use of personal protection equipment.
Any patient who presents with Ebola symptoms and has traveled to West Africa should trigger an immediate call to emergency authorities and public health officials, said Gluckman, who is also a consultant and instructor for the New Jersey State Police Hazardous Materials Response Unit. He said providers should encourage patients to call clinics before coming in if they think they might have Ebola, so that a staff member can go through the CDC checklist over the phone.
Dr. Ron Yee, chief medical officer for the National Association of Community Health Centers, an industry trade association, said in an e-mail that most community health centers have some personal protection equipment, but likely not enough for all staffers. An effort is underway with state partners to ensure health centers have adequate protection equipment, he said.
Follow Adam Rubenfire on Twitter: @arubenfire