John S. Oghalai, MD, Chair of the USC Caruso Department of Otolaryngology – Head and Neck Surgery, discusses the influence of COVID-19 has had on day-to-day patient care for otolaryngologists, and what clinical practices will remain in place moving forward at Keck Medicine of USC.
Hello. I'm John Ogle. I I'm the chair of the U. S. C. Caruso, Department of Otolaryngology Head and Neck Surgery here at Tech Medicine of USC. Today, we're gonna be talking a little bit about Covid 19 and how it's affected. The practice of otolaryngology otolaryngologist are at high risk of contracting Covid 19 from their patients. When we examine a patient were in their nose, their mouth, their throat were all around aerosol. And as we know, Covid, 19, has passed through droplets and aerosolization. It's dramatically affected the way we see patients in our clinic. We no longer can just go room to room to room, examining every patient and simply just washing our hands. In these days, it takes a lot more personal protective equipment to do this job safely because of the high risk of getting Covid 19 from patient in your clinic. Most otolaryngology practice is now require screening of patients, often the day before they come in, but also the day of entry into the clinic. They often get their temperature checked, they must don a mask. And, of course, all the health care workers within the clinics must take similar precautions for routine examinations that don't involve aerosol generating procedures. This is adequate, and the rate of transmission when both parties both the health care worker and the patient are wearing a standard surgical mask is negligible. E low. In fact, AT CAC as far as I'm aware, we have not had a single case where transmission has occurred in this way. The problem with otolaryngology practices, though, are that we do aerosol generating procedures in the clinic, such as endoscopy, video, stra, Bosc, API trade changes. And these are all situations where a standard surgical mask is not adequate. The patient has to take off their masks. The physician needs to then wear the full gamut of PPE, including a 95 masks. Face shields, surgical cap down. There are many consequences of the changes that we've had with our medical practice since the advent of Covid 19. They are critically important. I wouldn't change them at all. It's prevented transmission of Covid 19 between people, but it has affected our practice. It means that we can't see as many patients in person. Certainly telemedicine has increased in our practice. Telemedicine is almost a third of our clinic volume now and the benefit of this is for patients. They don't have to drive to your clinic. Um, it also opens up the waiting room so you're not having as many patients crammed into a tight space. But the downsides, though, are we can't do a lot of the procedures on these patients when it's a telemedicine appointment, and so they often have to make a separate visit for the in person business. Furthermore, you have to have a proper air exchange in your exam rooms, and that means having time to have the air change over before you can bring in the next patient. So this also slows down the rate at which we can see patients. There are several things that we can do to enhance the way we take care of our patients in this new day of covid 19. One of the things that we're doing here at USC is research to develop ways that we can see patients and examine them faster, but also with a high degree of safety. At USC, we've been doing research in developing a negative pressure mask. This is an N 95 level mask with gaskets that permit the endoscope to pass through into the nose or the mouth, and it also has a suction so that any aerosol generated by the patient is captured by the mask and goes into the suction rather than being dispersed into the room. Ongoing research trials with this mask are happening right now. It's a reusable mask, and I think it can be produced at a fairly inexpensive rate. And so we hope that this will allow us to quickly increase the volume of patients were able to perform procedures on in clinic. I think this is the new normal for otolaryngologist going forward. I can't imagine going back to the way we used to practice simply going from room to room to room so fast between patients. In fact, right now, frankly, it even seems weird to consider seeing a patient without wearing a surgical mask. Keck Medicine is really pioneering safety protocols to improve the care that we can provide to our patients expeditiously, but also extremely safely. We take this so seriously, I'm proud to be associated with this organization, and I'm happy that our patients can feel safe here. Thank you for your time. If you have questions either about our research or about our patient care protocols. Please feel free to reach out. We're happy to work with you. We're always here to help you.