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COVID-19 Disclosure Checklists for Health Care Workers, Patients and Families

07/24/2020

By David W. Baker, MD, MPH, FACP, executive vice president, Health Care Quality Evaluation, and editor-in-chief, The Joint Commission Journal on Quality and Patient Safety

Gautham Suresh, MD, DM, MS, FAAP, section head and service chief of Neonatology and attending neonatologist, Texas Children’s Hospital; professor of Pediatrics, Baylor College of Medicine; and deputy editor, The Joint Commission Journal on Quality and Patient Safety  

As COVID-19 continues to impact frontline workers and patients across the country, one area many health care organizations are still grappling with is how to best communicate and support individuals after a potential exposure? 

Notifying health care workers, patients and their family members about possible or known exposures to the virus is key to slowing the community spread. 

Two new articles in August issue of The Joint Commission Journal on Quality and Patient Safety (JQPS) from Brigham and Women’s Hospital, Boston, provide checklists to facilitate disclosure of COVID-19:

Checklist for Health Care Workers
“Given the risk from interactions with affected patients and stress associated with providing care, standardized, effective communication to health care workers regarding a potential exposure is important. This communication should encompass clear information regarding isolation, self-monitoring, testing and available support for health care workers,” notes the first article.

To address these needs, the study authors developed a standardized, comprehensive checklist to conduct complex disclosure conversations with health care workers. The checklist includes these steps:

  1. identify disclosure team
  2. initiate disclosure
  3. provide occupational health contact information
  4. review additional exposures
  5. review symptoms
  6. provide testing and isolation guidelines – if no symptoms or mild symptoms
  7. provide testing and isolation guidelines – if severe symptoms
  8. make determination regarding returning to work
  9. provide resources
  10. provide additional contact information

In addition, each step includes specific questions to ask and additional guidance.

For example, step 2 or “initiate disclosure” offers these questions to ask:

  • Has the health care worker been contacted?
  • Is the health care worker’s preferred language confirmed? 
  • Do interpreter services need to be activated?  

Additional guidance for step 2 includes suggested language: “We believe you may have been exposed to health care worker or patient who tested positive for COVID-19. To assist you with the next steps, we have information, resources and support tools available to ensure that you and your loved ones have the support you need.”

Checklist for Patients and Families
“When communicating health care-associated exposure to COVID-19, standard disclosure principles and practices apply. The goal of the disclosure process is to encourage open dialogue and a safe space for venting, conflict and resolution, with appropriate use of mediation and apology,” notes the second article.
To address these needs, the study authors developed a standardized, comprehensive checklist to conduct complex disclosure conversations with patients. The checklist includes these steps:

  1. identify disclosure team
  2. initiate disclosure
  3. review symptomology
  4. provide testing and isolation guidelines – if no symptoms or mild symptoms
  5. provide testing and isolation guidelines – if severe symptoms
  6. provide resources
  7. provide additional contact information

In addition, each step includes specific questions to ask and additional guidance.

For example, step 3 or “review symptomology” offers these questions to ask:

  • Have COVID-19 symptoms been reviewed?
  • Is the patient and/or visitor experiencing symptoms? What is the level of severity identified?
  • Have non-symptomatic patient and/or visitor recommendations been reviewed?

Additional guidance for step 3 includes suggested language: “My name is _______ and I’m calling from _______. I want to make you aware that an employee who cared for you/your loved one on [Date/Time] has tested positive for COVID-19. Because you were in close contact with this person for more than 15 minutes, there is the potential that you were exposed. To assist you with the next steps, we have information, resources and support tools available to ensure that you and your loved ones have the support you need.” 

The study authors from both articles believe the checklists can be a blueprint for other health care organizations to tackle the challenge of stopping community spread of COVID-19. The complete checklists are available through open access on the JQPS website.

To stay up-to-date on the latest COVID-19 information and resources from The Joint Commission, visit our COVID-19 resource portal.

David W. Baker, MD, MPH, FACP, is the executive vice president for Health Care Quality Evaluation at The Joint Commission. In this role, he leads the Department of Standards and Survey Methods, the Department of Quality Measurement, and the Department of Research. He oversees the development of performance measures, standards, survey methods, and National Patient Safety Goals for all Joint Commission accreditation and certification programs. He is also editor-in-chief for The Joint Commission Journal on Quality and Patient Safety.

Gautham Suresh, MD, DM, MS, FAAP, is section head and service chief of Neonatology and attending neonatologist at Texas Children’s Hospital in Houston. Dr. Suresh also is professor of Pediatrics at Baylor College of Medicine, Houston, and deputy editor of The Joint Commission Journal on Quality and Patient Safety. Dr. Suresh serves as chair of the American Academy of Pediatrics program, Education in Quality Improvement for Pediatric Practices, and as an associate editor of the Neonatal Review Group of the Cochrane Collaboration.