Up until the covid-19 pandemic, the Southern Colorado TMS Center was a “busy TMS clinic with about 25 or more patients a day. The waiting room was pleasantly full, and our patients often would come and socialize and chat with each other prior to or after their treatments. Patients would also stop by and ask the staff questions about scheduling, payments and other matters. Staff would often chat with the patients and visitors briefly as part of a deliberate plan to de-emphasize a medical feeling in the office,” says Medical Director Dr. John Fleming.

However, with the current Covid-19 pandemic outbreak, several issues not only needed to be addressed promptly, severe changes also had to be implemented in order to mitigate spread and be able to remain open. Dr Fleming and his staff have therefore “taken a series of progressively more restrictive steps by applying aggressive social distancing to limit contact situations and to increase barriers to potential virus spread where contact during treatment was required.”

First, three areas of opportunity were identified:

a. Reduce total interactions between people while at the clinic maximally
b. Reduce the potential for virus spread between home environments of both patients and staff and the clinic offices
c. Establish better barriers between techs and patients while TMS treatment was delivered

Minimizing contact and optimizing sanitization 

John Fleming here explains what this meant in reality: “We removed a number of waiting room chairs so that patients were able to keep 6 feet separation. We then moved on to asking people not to come early to appointments and asking for no visitor to come with them, then moving on to effectively shutting the waiting room by having patients wait in their cars until time of treatment and then departing immediately. All patient questions are handled by phone or text not face to face and we do not allow visitors to accompany patients any longer. When patients arrive in the parking lot, they text us, wait in the car until we text them to come in. The patients stop in the bathroom and hand wash thoroughly and may no longer bring backpacks and all cell phone must be left in their car or deep in a pocket.

Patients: Pre-screening 

"Arriving patients are met at door by the TMS technician who wears fresh gloves and face mask. Patient temperature is taken and the patient is placed in face mask. Patient is asked screening questions about own temperature, cough, and any potential exposures for themselves and for all with whom they live. If all questions are negative, the patient is brought into the treatment room for TMS. If questions are positive or if the patient has a fever, the patient must return to his or her car until the medical director can consult with the patient. While not a change in our procedure, we thoroughly decontaminate the room/chair/coil/desk between each patient. We take care that the patients do not touch door handles, light switches, and the like.”

Staff: Screenings and extra precautions

In terms of staff, there has also been some significant changes, according to John Fleming:

“We further reduced density by having staff who are not providing direct care to work from home. Remote access from homes to our computer systems were set up. We have reduced the number of staff in the clinic to four at any given time. Arriving staff undergo the same health screenings and temperature checks as patients daily. Steps to reduce outside virus load which might be present include having staff change out of travel clothing and into work clothing on arrival. They also wash hands and change to fresh gloves between each patient and will wear an N-95 mask during treatment. When leaving office, the technician changes out of office clothing back to travel clothing. Technicians are furthermore advised to change into at home clothing on arrival at home and to change shoes and clothing before entering their homes."

Positive patient response

“Our patients have reacted very positively and are appreciative of the steps we are taking and feel cared for. We have tried hard not to become emotionally distant from our patients while we separate them from each other and us in a way that reduces possible virus transmission,” says John Fleming.

Online conferences, not patient groups

Dr Fleming further explains how weekly patient education meetings are no longer held as a group session in the clinic but have been replaced by a zoom conference [“Zoom” is a web-based video conferencing tool] with patients in their own homes.

Most patients continue TMS treatments

About 25 % of Dr Fleming’s patients have had to pause their treatments for at least 14 days for various reasons. One patient does home health care with many elderly patients with virus symptoms. Two had spouses with significant coughs and fevers. Another patient lives with an immunocompromised spouse and felt the risks even with all this mitigation was simply not worth taking. We have learned that some patients are so motivated to get TMS treatment that they will minimize their reports to us of symptoms in an effort to not be turned away and this has proved to be an additional challenge.

Dr Fleming and his staff are prepared to temporarily pause clinic operations if necessary, but he remains hopeful that the aggressive actions that he has already taken will allow for them to continue, There are still numerous unresolved issues such as tests for the virus which, according to John Fleming, were only available for a few days in his state. It is currently unclear when this will change, he ends.

________________________

The views and opinions expressed in this article do not necessarily reflect the official policy or position of MagVenture or any of its affiliates. The usage of rTMS for any other purpose than the cleared indication, in the country in which the product is intended to be used, is considered investigational.

Covid-19|Corona: Please follow the guidelines from your local government and/or health authorities.