Our Expertise in Preventing Contagious Illness
Much of the world is now getting a crash course in viral transmission, inoculum size, viral particle shedding and management of risk factors. We want to give our patients and their parents/caregivers reassurance that these topics are at the center of our extensive educational background and Pediatric medical expertise. Regardless of the kind of germ that causes illness, preventing its spread between patients is at the heart of how Pediatricians move, work and navigate our work each day. Starting in medical school and extending into our professional environment at Redwood, preventing the spread of illnesses is a practical set of steps that comes out of years of education on the human body, the traits and characteristics of various germs, the dynamics of the immune system, and the changes in certain individuals that make a person weaker against a specific germ at a specific time. Just as airplanes are built only once thousands of hours of design is completed, Pediatric office design, layout, scheduling and cleaning is designed before the first patient ever sets foot into a Redwood office. While people cannot live in a bubble, there are many important steps that can be taken to restrict the spread of illness between patients, and we want you to know that at Redwood we use our expertise to meet or proactively go above and beyond governing body recommendations to keep our patients and staff healthy.
During the Pandemic, each patient calling for any type of appointment will be screened for risk factors for exposure to or symptoms of Coronavirus. Patients at risk of exposure or who have signs of infection will be sent to an appropriate testing site and not come to the office. This is a necessary step to protect the patients that choose us as their medical home.
Physical Distancing of Sick and Well Patients
In direct preparedness for this difficult and alarming illness, Redwood is setting up a disaster relief Mobile Clinic across the parking lot from our main clinic. Patients with signs and symptoms of illness which are different from Coronavirus will come to the mobile clinic to be seen there. Patient coming in for well checks, weight checks, newborn baby visits, behavioral health visits, foster care visits, non-contagious skin problems, and other non-contagious illnesses, will all come to our main office location. There will be ZERO overlap of sick and well patients at Redwood Pediatrics during this time. We will be staffing the two locations separately as well, so all staff who come into contact with your child will not have been around anyone sick that day. Clear instructions will be given as appointments are made. Please be assured that as of March 23, 2020, no sick patients will be in our main office location, and well visits and other necessary preventative and ongoing care will continue in as safe an environment as is possible. We will continue to follow the high standards of antibacterial cleaning between patients and at the end of each day, as well as our routine deep cleaning schedule.
During the pandemic, your ability to choose a specific provider for a visit may be limited and unexpected changes may be necessary. Please be flexible with us as we strive to do the right thing for all of our patients. Once the pandemic is over, we will be happy to offer the flexibility and choice of providers you have come to expect from Redwood Pediatrics.
Parking Lot Navigation
The Mobile Clinic will be in the southeast corner of the parking lot of our usual location at 9151 NE 81st Terrace, Kansas City, MO 64158. It will be plainly marked and easily visible. It has negative pressure rooms and multiple entrances and will offer every service that the main office does for sick patients. If you come for a sick visit, take the following steps once you arrive in the parking lot:
- Stay in your car and call the main office
- You will be checked in and make copays or any usual payments over the phone.
- The nurse from the mobile clinic will call your phone and indicate which door you should use to enter the mobile clinic.
- You will be seen as usual by one of our trusted providers and will go straight to your car again once the visit is over.
Given the contagious nature of Coronavirus, we must restrict additional patient family members from being in the office at Redwood. Ideally one caregiver and the patient will attend the visit, but two caregivers can attend. Babies 12 months old and younger will still be allowed to attend all visits with their family. No family members with a cough may come along for visits. We realize this may cause some difficulty for caregivers but is an absolutely necessary step to protect our young and most vulnerable patients.
Coronavirus Testing and Care
Should your child fail the screening questions during your initial phone call, you will be referred to either Children’s Mercy or another appropriate testing site for further evaluation.
If your child has cough and additional symptoms that require medical evaluation such as shortness of breath or 3+ days of fever, we will refer you to Children’s Mercy where testing as well as appropriate medical care can be administered.
Staff Training and Communication
Doctors and Nurse Practitioners all receive extensive training and expertise in infection control and prevention as well as treatment. At Redwood we maintain the highest standards for all clinical staff. All of our nurses are RN’s, meaning they have years more education and clinical training than the Medical Assistants (MA’s) that most offices employ. We also keep frequent and proactive communication between Doctors, Nurse Practitioners and nursing staff to provide up to the minute accurate clinical information for patients. One of our core values is to practice excellent communication , and this commitment becomes additionally critical during trying times such as the Coronavirus Pandemic. Please be assured that we are reading our professional resources daily, communicating changes in real time with our staff, and passing on the best information available to you to partner with you in caring for your children.
Generally, telehealth represents a low standard of care in Pediatrics, and there is more risk than benefit to it’s use in outpatient General Pediatrics. However, as risks of exposure to Coronavirus rise, the risk-benefit ratio changes. Redwood leadership has initiated offering Telehealth Visits now that Coronavirus is in our community. Similar to DefCon levels used in military settings based on imminent threat levels, we will operate on COVID-Con levels. As the burden of disease rises in our community, there is more and more reason to trade the quality of care offered in the in-office setting for the safety from exposure to COVID19 offered by Telehealth. Thus as COVID19 levels rise in our immediate area, we will allow more and more visit types via Telehealth. This approach is based on recommendations from national health experts as well as on the skills and experience of Dr. Billharz, whose medical experience in severely resource-limited areas in Ghana (child slavery evacuations), Malawi (HIV-decimated areas and malaria epidemic), and Haiti (displaced children) provide real-world experience in creative problem solving during times of crisis and elevated threat. In conjunction with local authorities’ recommendations, Redwood Pediatrics will scale telehealth up or down according to the threat level imminent to our community to provide the best care for your child, whether that is in the main office, in the Mobile Clinic, or by Telehealth visit.
If a telehealth is deemed appropriate for your child, caregivers will need access to their portal account, will need to be ready for the visit 5-10 minutes early to allow time to sign in and set up their phone or computer with appropriate lighting, volume control and microphone settings in place, and will need to write down their child’s heart rate (number of beats in 60 seconds), breathing rate (number of breaths per minute), weight without clothes on, and temperature (place in mouth or armpit, completely covered by skin, don’t add a degree) around 20 minutes before the start of the visit. Costs associated with telehealth should be covered by insurance companies, but if they are not, caregiver are responsible for all associated costs.
To schedule a telehealth visit, call the office at 816.207.0070 and speak to the front desk. The process is the same as scheduling any other type of visit.
Redwood Pediatrics will use the following guide based on immediate threat of COVID19 exposure while in public, combined with your child’s health concern, to determine if a telehealth visit is the best option for care:
COVID-Con Level 1:
General Rule: A limited number of visit types are appropriate for telehealth. While diagnostic accuracy and certainty will be better with an in-office visit, these visit type represent a lower risk of loss of quality through a Telehealth visit.
These problems tend to be diagnosed somewhat accurately through history, have unlikely or few serious complications, or have treatments with low risks.
Only the following visit types are appropriate for telehealth at COVID-Con Level 1:
-Patients without confirmed COVID19 exposure but with all 3 of these symptoms: cough, fever,
-Patients w/known first hand exposure to a COVID19 tested (+) patient with any 1 of these 3
symptoms: cough, fever, stomach ache
-diarrhea without fever or blood in stool
-infants with concern of gastric reflux or colic
-infants with concern of thrush
-infants with concern of rash (with no gastrointestinal or respiratory symptoms)
-swollen lymph nodes
-infected fingernails or toenails
-Medicine checks for mood disorders or ADHD
-asthma follow up visits (standard 6 month follow ups with no current asthma symptoms)
-vomiting without fever (vomiting with fever must still come in)
-head injuries/concussion concern
-rashes without fever or nasal congestion, including acne
-sleeping difficulty in kids 2+ years old
-anxiety or depression
COVID-Con Level 2:
General Rule: An expanded number of visit types are appropriate for telehealth. Diagnostic accuracy and certainty will be much better with an in-office visit, but higher risks of COVID19 exposure reasonably outweigh these differences in quality during this limited time frame. These visit types and their treatments represent a moderate risk of loss of quality through a Telehealth visit. Close follow up will be recommended in most circumstances.
These problems tend to be diagnosed through a combination of careful history and exam, have moderate likelihood of serious complications, or have treatments that have increased risks.
In addition to the visit types in COVID-Con Level 1, the following visit types are deemed appropriate for telehealth at COVID-Con Level 2:
-Skin Abscesses (often thought to be spider bites by parents)
-Leg pain, including knee injuries
-Rashes with fever
-sleeping difficulty in children less than 2 years old
-sinusitis (10+ days of congestion, headache, fatigue in kids 7 years old and older)
-rhinosinusitis (14+ days of nasal congestion in kids less than 7 years old)
-genital rashes/diaper rashes/yeast infections
COVID-Con Level 3 (highest level):
General Rule: Almost every visit type is deemed appropriate for telehealth. Diagnostic accuracy and certainty will be much better with an in-office visit, and telehealth would typically be thought of as unacceptable in any other circumstance aside from a serious disruption such as a tornado, flood or pandemic. The exceedingly high risk of COVID19 activity in the community may necessitate this low level of care as it may be the only available option. These visit types and their treatments with prescription medicines represent a significant loss of quality of care through a Telehealth visit. Close follow up will be required in most circumstances. In some cases careful observation of the patient will be used by the provider during the visit in place of definitive care. This will be done to determine if a condition with a known cure can wait or if immediate evacuation, despite significant external risks, is medically indicated. Many visits will lead to a referral to a hospital ER (if one is available) for definitive care of a serious or life-threatening illness or injury.
These problems tend to be diagnosed with a heavy dependence on physical exam, have a high likelihood of serious and permanent complications if not treated quickly and accurately, or have treatments that have high risks.
In addition to the visit types in COVID-Con Level 1 and Level 2, the following visit types are deemed appropriate for telehealth at COVID-Con Level 3:
-chronic stomach pain
-weight loss in children less than 2 years of age
-prolonged fever (5+ days over 100.5 each day as measured by thermometer without adding)
-febrile seizure or abnormal movements
-sore throat or concern of strep throat
-significant head trauma with loss of consciousness or vomiting
-lacerations usually requiring stitches or other medical attention
-foreign bodies in nose or ears
-dehydration (less than 6 wet diapers in 24h for 0-11 months old, less than 4 urinations in 24h
for 1-3 year olds, less than 3 urinations in 24h for 4+ year olds)
-burns covering more than the size of the patient’s hand, but located anywhere on the body