Table 1.

summarises the various methods that may be used to reduce infection of staff and patients while delivering elective clinical services

ConceptExample
Hospital avoidanceClinic consultations by telephone or video call
Elective procedure consent by telephone or video call
Strict rules on permission for friends or relatives to join patient for hospital appointments
Hybrid care – specialist advice from hospital and hands on treatment in community
Decentralised care – physiotherapy, rehabilitation, delivered in community settings
Patient separationUnidirectional flow with separate entrances and exits into hospital and clinic sites
Avoid mixing inpatients and outpatients
Provide elective services at different sites or times to inpatient services
Increased physical spacing in reception areas
Patients to wait outside while awaiting being called in to be seen for appointment
Drive-through services for pharmacy collections, pacemaker checks and other amenable services
Pre-admission screening for COVID-19Questionnaire
Temperature check
Testing for active infection
Self-isolation
Possible role for immunological testing
Infection controlMeticulous hand hygiene by staff and patients
Frequent cleaning of clinical and non-clinical areas
Appropriate PPE
Sufficient access to PPE
Special protection for high-risk workers, eg enhanced PPE, alteration of clinical duties
Face masks for staff and patients
Frequent testing of asymptomatic staff
Electronic conferencing, remote working and doctor educationEncourage remote telephone/video conferencing to reduce mixing of staff where possible, eg MDT, management meetings
Promote off-site working for administration, SPA duties, remote clinics
Enhance new ways of medical education including online tutorials, lectures, video tutorials, simulation, virtual reality
Alternative clinical pathwaysConsider diagnostic and treatment approaches with similar efficacy but lower infection transmission