Landstuhl Regional Medical Center


COVID-19 Risk Reduction and Response

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Regional Health Command Europe COVID-19 Information 

Please review very important information regarding hospital operations during the COVID-19 outbreak. You can get information on specific clinics and departments below.

COVID Advice Line

If you have questions about the coronavirus, please call our COVID-19 Advice Line at DSN 314-590-8000 or CIV 06371-9464-8000. The line is staffed by LRMC personnel Monday-Friday, 7:30 a.m.-4:30 p.m to answer your questions. If you call after hours, you can stay on the line to be transferred to the TRICARE Nurse Advice Line.

You can also send an email to usarmy.lrmc.covidquestions@mail.mil. Our staff are standing by to answer your questions about the coronavirus, test results and more.

Initial Screening

Before entering the hospital, every individual is asked to conduct a self-screening with the list of questions displayed at entrances pertaining to risk of exposure / symptoms of COVID-19.

COVID-19 Screening Clinic (CSC) / Acute Respiratory Clinic (ARC) (Effective Oct. 5)

COVID-19 Screening Clinic

The LRMC COVID-19 Screening Clinic (CSC) is open 7:30 a.m. - 4:30 p.m., seven days a week and is located next to the LRMC Emergency Department. Patients requiring screening outside the hours of operation will be seen at the Emergency Department.

The CSC is for patients without symptoms who need a COVID-19 screening for reasons such as pre-operative, return-to-work, or dental appointments, for example.

Acute Respiratory Clinic

The Acute Respiratory Clinic (ARC) will be available for those with cold, flu, or COVID-19 symptoms. ARC hours will be
Monday - Friday from 7:30 a.m.-4:30 p.m. (except holidays/family days/training holidays).

Any military ID card holder needing COVID-19 testing because they have symptoms can be seen on a walk-in basis at the ARC clinic. The ARC is located in wing 1F of the main hospital with recommended parking in lot 5 (P5). Upon arrival, please enter the waiting room, take a ticket, and return to your car to await a phone call. This will help reduce the amount of patients in the waiting area and ensure social distancing guidelines.

When entering post and arriving at the T-intersection, look for the signs on the Green Fence directing you to turn Left for the CSC (green sign) or Right for the ARC (gold sign). Then follow the green or yellow arrows to the correct clinic location.

On weekends or after hours, if you have cold, flu, or COVID symptoms, please continue to visit the Emergency Department. Symptoms include fever, cough, sore throat, shortness of breath, fatigue, muscle aches/pains, headache, loss of taste/smell, congestion/runny nose, nausea/vomiting/diarrhea.

Landstuhl Regional medical center COVID 19 screening and acute respiratory clinic flyer. Flyer contains the following information. COVID 19 screening clinic, or C S C, open 7 30 to 4 30 Monday thru Friday for patients with no symptoms, and Saturday Sunday for all patients. Acute respiratory clinic, or A R C, for patients with COVID 19, flu, and cold symptoms, open Monday thru Friday 7 30 to 4 30.

IMPORTANT INFORMATION FOR VISITORS

Effective 18 MAR 2020, LRMC will begin limiting visitors to all inpatient wards:

Do not visit patients if you have a cold or flu-like symptoms, including fever, cough, or shortness of breath. Any visitors displaying such symptoms or who are experiencing other illnesses will be asked to leave for the safety of our staff, patients and themselves.

  • Visitations will be limited to one adult care giver or visitor per patient at any one time, 18 years of age or older.
  • Siblings younger than 18 years of age will not be allowed into a patient's room or in any common inpatient areas.
  • Visitors will be screened daily upon entering the hospital.
  • Visitors will need to log-in and provide a telephone number where they can be reached.
  • Visitors are not allowed in the Identified COVID-19 wards.
  • Pregnant patients in labor are authorized 2 visitors total during labor, and 1 visit during post-partum recovery. Age restrictions are in place, and visitors must be over the age of 16 and under the age of 60.


There will be limited exceptions for End of Life/Palliative Care (requires authorization by the Officer in Charge of the Medical-Surgical Ward), Labor & Delivery and Neonatal Intensive Care Unit (requires authorization by chief of Women's Health Nursing and Newborn Clinic).

Please understand that these limitations are in place to reduce the exposure risk and spread of COVID-19. We truly appreciate your support and compliance to these measures as we continue to navigate this global pandemic.

Emergency Department Visitation Policy

Effective 26 MAR 2020

Due to escalating spread of the COVID-19 virus, effective immediately, NO VISITORS will be permitted in the LRMC EMERGENCY DEPARTMENT except under the following specific circumstances:

- One parent or caregiver of a pediatric patient.
- Person serving as surrogate decision maker for a patient.
- Person in an official governmental function.
- One family member or guardian of a patient with disruptive behavior, where a family member is key to their care.
- Caregiver of a patient with altered mental status or developmental delays (where caregiver provides safety).

No children will be allowed in the LRMC Emergency Department as visitors. An exception to this policy pertains to single parents who have no other way of providing child care.

All visitors will have their temperature taken during triage process, together with the patient they are accompanying.

We understand the frustration and issues this may cause with some patients, but we appreciate your adherence and support as we continue to make necessary changes for the safety of both our staff and patients.

Clinic/Department Information

Audiology Clinic & Hearing Conservation Clinic
CHANGES TO HOURS OF OPERATION: No change

CHANGES TO APPOINTMENTS: Hearing Readiness Booth is by appointment ONLY - Please arrive 10-15 minutes before your appointed time. We are currently unable to see walk-in patients due to COVID restrictions. Call DSN 590-5762 or CIV 06371-9646-5762 to schedule appointment.

CHANGES TO SERVICE CAPABILITIES: The Audiology Clinic is currently scheduling Active-Duty only. Other patient categories and beneficiaries are seen on a Space Available basis. Referrals from Primary Care Managers will be reviewed for eligibility.

CARDIOLOGY CLINIC
CHANGES TO HOURS OF OPERATION: No change (7:30 a.m. - 4:30 p.m.)

CHANGES TO APPOINTMENTS: The Cardiology Clinic will contact patients with scheduled appointments that will be cancelled. We will attempt to address any issues via Virtual/Tele Health for routine follow-up to minimize exposure risk to COVID-19. Patients who are not routine follow-up will be seen in clinic or via telehealth at the discretion of the Cardiologist. New patient referrals will be triaged as a routine consultation or a non-routine consultation. Patients triaged as routine will be contacted and scheduled for a future routine visit as appropriate. Patients triaged to non-routine consultation will be seen by either telehealth or in clinic at the discretion of the Cardiologist.

CHANGES TO SERVICE CAPABILITIES: Walk-in services will be limited to ECGs for preoperative examination, PHA and employment purposes.

CHILD & FAMILY BEHAVIORAL HEALTH SERVICE
CHANGES TO HOURS OF OPERATION: No changes

CHANGES TO APPOINTMENTS: Cancellation of certain appointments for the next 30 days. Possible cancellation of certain appointments for the next 60 days, will update as required. Clinic staff is contacting patients affected to reschedule.

CHANGES TO SERVICE: Patients with appointments must be seen in clinic and will get a phone call ensuring they will be present for scheduled appointments. Patients are advised not to bring sick children or present to clinic if ill. If a patient is interested in or needs care, they should call CAFBHS to schedule an appointment at DSN 590-6311 / CIV 06371-9464-6311.

CHIROPRATIC SERVICES
CHANGES TO HOURS OF OPERATION: No changes

CHANGES TO APPOINTMENTS: Beneficiaries with changes to their appointments will be contacted directly, if no contact then patient should continue with scheduled appointments. If patients wish to cancel, they should contact the appointment line.

CHANGES TO SERVICE CAPABILITIES: Currently Active-Duty only. All other appointments have been suspended in addition to geographically separated beneficiaries.

DERMATOLOGY CLINIC
CHANGES TO HOURS OF OPERATION: No change.

CHANGES TO APPOINTMENTS: All patients with non-emergency scheduled appointments are being contacted via phone call to either address issues over the phone, if possible, or to cancel. We will attempt alternate methods of contacting patients who are unavailable via phone; please ensure your email address is updated in the TRICARE system.

EVOLUTION CLINIC(Trauma Intensive Outpatient Program)
CHANGES TO HOURS OF OPERATION: No change (7:30 a.m. - 4:30 p.m.)

CHANGES TO APPOINTMENTS: Whenever feasible, we are conducting aftercare appointments via Virtual Health. At a later date, and when we may safely resume face-to-face services, we will contact the members that have been accepted into the program to reschedule.

CHANGES TO SERVICE CAPABILITIES: All classes are suspended until further notice. Referrals will still be accepted but will be put on a waiting list. Please call CIV 06371-9464-6302 or DSN 590-6302 during normal business hours for questions.

EXCEPTIONAL FAMILY MEMBER PROGRAM(LRMC)
CHANGES TO HOURS OF OPERATION: No change (7:30 a.m. - 4:30 p.m.)

CHANGES TO APPOINTMENTS: All scheduled appointments are cancelled until further notice.

CHANGES TO SERVICE CAPABILITIES: There are no walk-in services available. LRMC families who need EFMP enrollment or update should call CIV 06371-9464-5756 or DSN 590-5756.

FAMILY MEDICINE CLINIC
CHANGES TO HOURS OF OPERATION: No change (7:30 a.m. - 4:30 p.m.)

CHANGES TO APPOINTMENTS: We are in the process of converting as many scheduled appointments to Virtual/Tele Health appointments as possible. We have also identified patients with acute needs who still need to be seen face-to-face. Unless you are notified of a change to your appointment, please arrive as scheduled.

CHANGES TO SERVICE CAPABILITIES: There are no walk-in services available.

GASTROENTEROLOGY CLINIC
CHANGES TO HOURS OF OPERATION: No change (7:30 a.m.-4:30 p.m.)

CHANGES TO APPOINTMENTS: All appointments are currently still active; however, appointments will be conducted telephonically. This prevents patients from having to come into the hospital and risking exposure to COVID-19. Providers will discuss symptoms and will make the determination if a face-to-face appointment is needed. For new referrals, providers are determining whether or not the patient needs to be seen face-to-face or if their issue can be addressed via a Virtual Health/telephonic appointment, or if the issue can wait until normal operating services resume. Only diagnostic procedures for symptomatic patients are being conducted at this time. Procedures fitting this category are being triaged by the physician to determine what is necessary and what can be deferred for 30-60 days.

CHANGES TO SERVICE CAPABILITIES: Only diagnostic procedures for symptomatic patients are being conducted at this time. Procedures fitting this category are being triaged by the physician to determine what is necessary and what can be deferred for 30-60 days.

INTERNAL MEDICINE CLINIC
CHANGES TO HOURS OF OPERATION: No change (7:30 a.m. - 4:30 p.m.)

CHANGES TO APPOINTMENTS: All appointments that are currently booked will be conducted via Virtual/Tele Health, and all patients are being called to confirm this request. A message has been sent via the TRICAREOnline patient portal, and information regarding this change in appointment type has been given to the Appointment Line Call Center. Providers will inform the patient of any need for a follow-up face-to-face appointment after the Virtual/Tele Health appointment has been conducted. All bookable appointments available through TRICAREOnline or the Appointment Line will be for Virtual/Tele Health appointments only. Other arrangements will be made to bring patients into the clinic only if determined necessary by the provider.

CHANGES TO SERVICE CAPABILITIES: All 24HR ambulatory blood pressure monitoring will be cancelled unless directed by the physician. Those patients who were previously scheduled for this service are being notified of this cancellation.

MULTI-D EMBEDDED BEHAVIORAL HEALTH CLINIC
*ACTIVE DUTY ONLY*

CHANGES TO HOURS OF OPERATION: No change

CHANGES TO APPOINTMENTS: Patients requiring face-to-face appointments will continue as scheduled (will be contacted by clinic staff day prior). Patients whose care has been rescheduled as a virtual health appointment or postponed will be contacted by clinic staff.

CHANGES TO SERVICE CAPABILITIES: Clinical staff now utilizing virtual health capabilities to maximize social distancing, to include the orientation group which will be hosted by credentialed providers, unit/brigade consultations and psychoeducation. Service members will be provided resources to routes for BH care access for non-emergent/emergent care needs during this period.

NEUROPSYCHOLOGY CLINIC
CHANGES TO HOURS OF OPERATION: No change.

CHANGES TO APPOINTMENTS: Patients will be screened telephonically the day prior for any symptoms of COVID-19. If negative, the appointment will continue as scheduled. The referral process will remain unchanged. Patients should see minimal impact (please see next paragraph for non-local patients).

CHANGES TO SERVICE CAPABILITIES: Any patient coming from out of town (farther than 1 hour) may be rescheduled due to lack of lodging. These patients should contact the clinic to resolve these issues.

OUTPATIENT BEHAVIORAL HEALTH CLINIC
CHANGES TO HOURS OF OPERATION: No change.

CHANGES TO APPOINTMENTS: Patients requiring face-to-face appointments will continue as scheduled (will be contacted by clinic staff day prior). Patients whose care has been rescheduled as a virtual health appointment or postponed will be contacted by clinic staff.

CHANGES TO SERVICE CAPABILITIES: Currently orienting units/brigades to changes in clinic functioning, how to establish VTC/telephonic consultation services and psychoeducation-forward ways of using VTC with unit/brigade leadership and SMs.

OBGYN CLINIC
CHANGES TO HOURS OF OPERATION: There are currently two shifts for OBGYN operations: 8 a.m.-12 p.m. with last appointment at 11:30 a.m.; 1-5 p.m. with last appointment at 4:30 p.m.

CHANGES TO APPOINTMENTS: The OBGYN Clinic is contacting any patient with an appointment that will be cancelled. The clinic leaders are reviewing appointments scheduled through May to determine which appointments can be safely deferred for care in 30-60 days. Several patients have appointments that can be converted to Virtual/Tele Health appointments, such as those to review labs/imaging or concerns that do not require face-to-face encounter. Those patients are being notified of the appointment type change. All Centering classes have been cancelled. Participants in this program are being scheduled for one-on-one OB appointments.

All 6-week post-partum examinations are delayed until further notice unless there is an issue. All 6-week post-partum examinations for complicated or high-risk pregnancies are not impacted; please arrive for your appointment as scheduled.

All scheduled infertility appointments are deferred until further notice.

CHANGES TO SERVICE CAPABILITIES: All group Genetics or NPCL appointments are cancelled until further notice. All pre-op appointments for elective surgeries are cancelled through May.

OB ULTRASOUNDS: Out of an abundance of caution for both the expecting mother and staff, visitors are no longer permitted during OB ultrasounds. Due to the close proximity of the ultrasound technician and the patient, we are taking extra precautions to reduce risk exposure by permitting only the tech and pregnant patient in the exam room.

Effective 8 APR 2020

All patients with scheduled cesarean sections or indicated induction of labor will be tested for COVID-19, to include those who are asymptomatic. Testing must be completed 24 hours prior to your scheduled delivery at the LRMC COVID-19 Screening Clinic. Your provider will call if you with results if any necessary actions must take place prior to your delivery.

The staff in the COVID-19 Screening Clinic are taking every precaution for your safety, and theirs, and will be uniformed in proper personal protective equipment (PPE). Testing in the clinic does not take long, and should you be in the clinic at the same time others are being tested, you will be asked to physically distance from each other. The clinic staff thoroughly wipe down the waiting area and exam room after each patient encounter, and the COVID-19 Screening Clinic is professionally deep cleaned four times per day.

OBGYN FAQs

Q. Are there any discussions about modifying the 2 visitor rule down to one/zero as the other local hospitals are doing?

Yes, we have updated our visitor policy for both Labor & Delivery and the post-partum ward. There is only one visitor per patient allowed during both labor and delivery, and post-partum recovery. Patients who have tested positive for COVID-19, or is considered a Person Under Investigation (PUI) are not permitted to have visitors.

Q. Is the staffing at Labor and Delivery lower to try and mitigate potential exposure? If so/not, is there any impact to laboring patients?

No, there is no reduction in staffing on labor and delivery. We are staffed with safety and quality of care at the forefront. We are following CDC guidelines of hand washing/hand gel use, social distancing and screening all visitors to our area to reduce exposure.

Q. Is it a possibility that husbands will not be allowed to attend births? What would cause that to happen, if so?

We understand the importance of having your significant other present during the birth of your child. However, there is always the possibility that the entire hospital moves to a no visitor policy. Labor and delivery, as well as the post-partum unit, would modify the visitor policy in accordance with the hospital's visitor policy.

Your spouse, if active duty, is eligible for parental leave in order to help you with your recovery and childcare when at home.

Q. Will the Patient Liaison Officers still be available to those who are delivering on the economy, specifically for my case in Homburg?

The PLOs will still be available, though they will likely be conducting a lot of business and communication via phone in order to mitigate risk.

Q. Is there a way to ensure that 6-week post-partum appointments are not cancelled or conducted via Virtual/Tele health? A mother's care needs to be taken seriously and post-partum depression cannot be detected over the phone.

We take maternal care very seriously. We made every effort to minimize the loss of access to care for our patients. Our clinic has only reduced access by about 20% during this time period because we understand how important a face-to-face encounter is to many patients. The decrease in access was done so that we could reduce the risk of COVID exposure to our patients. We did a 100% chart review to assess post-partum risk and safely determine which patients we could reschedule for appointments at a later date. Post-partum examinations for higher risk patients, including those with a higher risk for post-partum depression, are still being scheduled as a face-to-face visit. Depression screening can still be performed via a telephone visit and as long as the patient is honest in her answers, and an appropriate referral to Behavior Health can still occur at that time.

Patients are encouraged to reach out to the OBGYN clinic directly should there be any change in status from an uncomplicated recovery. Based on the triage discussion, the patient may be brought in for a face-to-face appointment.

Q. Can we get more information on what type of appointment is considered essential (i.e, I see a lot of people getting an anatomy scan canceled and I'd consider that essential) or how we should reach out to the OBGYN office if the phone lines (are very understandably) busy all day? I have a 28 week appointment coming up and I've been unable to reach anyone for a few days on the nurse line to follow up on something. I know the staff are working hard and we appreciate it!

We understand the difficulties in accessing the Nurse Advice Line at this time. Please keep in mind that the Nurse Advice Line receives calls from TRICARE patients from around the globe; they are working on increasing network bandwidth as well as staff.

However, OB patients can call the OBGYN clinic to speak to one of our Triage nurses directly. If you have secure messaging with our clinic, patients can also send their questions to us that way.

Essential appointments are those in which a delay in care could lead to a negative outcome. Anatomy scans were recently cancelled by our Radiology Department for those patients in the upcoming 2 weeks only (through the first week of April). However, the plan was for those scans to be rescheduled after the 2 week period. The current recommendation is for an anatomy scan to occur between 18-22 weeks of pregnancy, so the range allows a small amount of flexibility in scheduling. Our clinic is currently reaching out to some of these cancelled patients who are closer to the tail-end of that recommendation for an anatomy scan in order to get their scan done in our Perinatology Clinic. The OBGYN Clinic now plans on scheduling an OB appointment on the same day that the patient has an anatomy scan (in Radiology or Perinatology). However, should we have illness within our provider/technician teams, that may change.

In addition, we just received guidelines on scheduled OB care. We will now be conducting the first dating ultrasound at the same visit the new OB is scheduled. This will be an hour long appointment to be scheduled between 10-12 weeks of pregnancy, again, reducing the amount of visits that patients have to the hospital. We will be removing the 16 week and 24 week OB appointments and can conduct a phone visit unless a patient has complications that require additional visits face to face.

Q. How do the new COVID operations at LRMC impact the newly pregnant mothers coming in? Some host nation hospitals are not accepting TRICARE Select at this time ,so will that continue?

Currently, the LRMC OBGYN Clinic is only accepting new OB patients who are covered under Tricare PRIME. We are unable to accommodate patients that are covered under TRICARE Select at this time.

Q. Is there talk of voluntary/early inductions to try to pace the L&D floor?

There are no voluntary inductions of labor at this time. The OBGYN Clinic may offer induction after 39 weeks gestation based on labor and delivery space, staffing, any co-morbidities in the pregnant patient and cervical favorability.

Q. What kind of circumstances would come up that would force those of us who want to deliver at LRMC to have to deliver at a German hospital?

For a pregnant woman receiving her care at LRMC, she would be expected to deliver at a German hospital only if our labor and delivery was at full capacity because we had no bed availability. We currently have no plans to stop delivering OB care at LRMC. In addition, we have contingency plans in place in the event that we receive a COVID positive laboring patient. These patients will be cared for in our hospital unless there is a medical indication otherwise.

TRICARE Select patients who have been receiving their care at a host nation healthcare facility will still be able to deliver on the economy. German OB physicians are not sending these patients back to LRMC. Even if one of their facilities starts to decrease services for OB care, they have contingency plans for where they would want to their patients to deliver.

Q. Are mothers (and possibly fathers) going to be tested upon admittance or sometime around there so to protect the staff and newborn baby?

Testing for COVID-19 is based on the current CDC guidelines. There are currently no guidelines recommending blanket testing for all pregnant women (and partners) upon admission.

Q. Any chance of making some of the tours or classes virtual that we can no longer attend in person?

Thank you for your suggestion! Currently, there are no classes or tours being conducted virtually, but it is something we will consider moving forward.

Q. I have an 8-year old daughter who we wanted to attend the birth, along with my husband and doula. Finding childcare for what could be days during a pandemic when everyone is supposed to be social distanced/quarantined is next to impossible without putting my daughter or the other family at risk. Are there exemptions or plans being made to support our families while mothers are in L&D and recovery after?

There are no exemptions to the number of visitors allowed in our labor and delivery rooms and post-partum ward. We recommend that family members begin to initiate or develop emergency care plans now so that it is in place when the pregnant patient is admitted. However, there is a possibility that the father may have to remain at home caring for another child(ren) if childcare is an issue when the mother is admitted.

Q. Is there any consideration to have pregnant and the newly post-partum women with newborns to have a separate entrance than everyone else?

The hospital has designated specific entrances in order to conduct the appropriate screening for COVID-19. This screening is important for all populations. There is no plan for a separate entrance for postpartum mothers or their newborns.

Q. Is there a way that pregnant women with symptoms can be screened away from other sick people?

Any patient with COVID-19 symptoms has the potential of carrying a pathogen that is infectious to others. Therefore, appropriate hand hygiene, social distancing and wearing a mask when arriving to the hospital is important no matter what the type of infection. The hospital has designated specific areas to conduct this important screening to prevent the spread of disease to others that have no symptoms.

Q. Is there any talk of amending profiles to stay home/quarantine? Everything I read on CDC says we are "at risk" and my office, although not customer service is continuing on with split-shift minimal manning. It seems there isn't any consistency across different bases/commands as to how pregnant women are being advised.

Currently, the CDC does not have information from published scientific reports about susceptibility of pregnant women to COVID-19. Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19. Pregnant women also might be at risk for severe illness, morbidity, or mortality compared to the general population as observed in cases of other related coronavirus infections and other viral respiratory infections, such as influenza, during pregnancy. Pregnant women should engage in usual preventive actions to avoid infection like washing hands often and avoiding people who are sick. In other words, there is no higher risk to pregnant women exposed to COVID as to influenza or other viral respiratory illnesses.

At this time, guidance has been for liberal teleworking for jobs that can support telework. Pregnant patients are encouraged to engage in open dialogue with their supervisors about transitioning all or part of their duties to telework if their job is amendable to this type of work. OBGYN is not providing letters or profiles indicating that a pregnant woman needs to stay at home. Quarantine is only indicated for those who have been identified as a close contact of a person with a confirmed COVID-19 infection.

Q. After delivery, how is the 'take baby home classes' being done with the restrictions of gatherings?

The discharge classes are no longer being held as a group in the Mother-Baby Unit. We are utilizing bedside discharge instructions and watch the discharge videos in the patient's room.

Q. Are you keeping moms as long (24-48 hours) after delivery or trying to release them earlier?

The minimum length of stay following a delivery is 24 hours. We can have a discussion with a patient that is motivated to leave at that time and who has no other medical indication to remain in the hospital. However, length of stay is sometimes determined by the baby's status following delivery. We are no longer allowing boarding status so that we do not keep patients in the hospital beyond the time that the mother meets discharge criteria.

Q. What type of appointments are being rescheduled? How do we know if we can keep our existing appointments?

Only essential appointments are being kept as face-to-face. Some appointments are conducted via telephone call. If an appointment is being cancelled, the patient will be called by our clinic in order to let them know.

Q. Will the new visitor policy also bar doulas from serving their clients during labor?

Doulas will be subjected to the one visitor policy. If your doula is identified as the birthing partner, he or she will be the only person allowed with the patient during labor and delivery.

Q. Are the nurses/midwives going to stay with the laboring moms if we go to a no-visitor policy?

The nurses and midwives can assist with labor support for the patient but they also have other patient care to perform and therefore may not be able to remain in the room the entire labor process.

For COVID positive patients or persons under investigation for COVID at the time of admission, no visitors will be allowed in order to minimize risk to the healthcare team and to the delivering infant. These patients will have a dedicated laboring team in which there is one-to-care the entire labor and recovery process.

Q. What is the plan for support during labor if the hospital moves to a no-visitor policy? Are you bringing in more staff so women have support?

Our labor and delivery nurses as well as the remainder of the delivery team assigned to the patient will provide caring and compassionate care and support during her labor.

Q. Why are spouses/support persons considered "visitors?" They are also part of the birthing process.

Any person who is not admitted to the hospital as a patient is considered a visitor to the facility.

Q. If the hospital moves to a no-visitor policy, will the nursing staff be able to help keep our spouses/birthing partners part of the process through photography and virtual services (e.g., Facetime)?

Video/photography/virtual services of procedures is still not allowed. Photographs of the mother and infant after delivery can be taken by staff and forwarded to the spouse/family members.

Q. If the hospital moves to a no-visitor policy, would it be possible to make an exception for the spouse/birthing partner if they tested negative for COVID?

The false negative rate for testing asymptomatic persons is unacceptably high (67%). That means that a negative spouse/partner could still be shedding the virus despite a negative test. This will put the healthcare team, you and your baby at risk.

The only exceptions to the no-visitor policy, following the hospital’s current guidance, is end of life or bereavement situations.

Q. Is there currently an anticipated date for this restriction to be lifted?

There is currently no anticipated date for the hospital visitor policy to change.

Q. Will exceptions be made for women in L&D/MBU who are nursing another child at home?

Children under the age of 16 are not allowed in the hospital as visitors. Therefore, they are also not allowed to come into labor and delivery or the post-partum units. We encourage you to work with our Lactation Consultants for means to keep your breastmilk supply going for your other child(ren).

Q. Do the decision makers consider the recommendations from the World Health Organization?

We are following guidance issued by the CDC, as well as the American College of Obstetricians and Gynecologists and Society for Maternal Fetal Medicine which are the organizations more specific to the specialty of obstetrical care.

Q. Can someone drop a gift off at the MBU without actually being considered a "visitor?"

A person may drop a gift off at the front desk. The gift may need to be wiped down to avoid potential transmission of coronavirus on the surface of the gift.

OCCUPATIONAL THERAPY
CHANGES TO HOURS OF OPERATION: No Changes (M-F 7:30 a.m. - 4:30 p.m.)

CHANGES TO APPOINTMENTS: Clinic staff will contact patients if there are any changes to appointments.

CHANGES TO SERVICE CAPABILITIES: Chronic conditions (ganglion cysts, tendonitis, etc) will be seen once normal operations resume. Priority of care will be for post-op or acute issues/injuries that need immediate care. Order of precedence will be Active Duty, Family Members of Active Duty, and then other eligible beneficiaries. Beginning to utilize virtual health as an option for patients, to include house calls.

PAIN MANAGEMENT CLINIC
CHANGES TO HOURS OF OPERATION: No change

CHANGES TO APPOINTMENTS: Reduction in available appointments. Patients with cancelled/ rescheduled appointments will be contacted at least 24 hours before appointment.

CHANGES TO SERVICE CAPABILITIES: Leveraging virtual health capabilities to maximize social distancing and safeguard staff and patients. Care will be available for urgent/ emergent cases, with routine management of chronic conditions conducted via virtual health. Suspending interventions which consist of corticosteroid administration (epidurals, joint injections, nerve blocks, nerve ablation, etc.), high-risk elective procedures, acupuncture, Functional Recovery Program, and the Intensive Outpatient Program.

PEDIATRIC CLINIC
CHANGES TO HOURS OF OPERATION: No change (7:30 a.m. - 4:30 p.m.)

CHANGES TO APPOINTMENTS: The Pediatric Clinic will maximize Virtual/Tele- Health evaluations, so the following appointments types will be rerouted to:

Virtual/Tele Health
- EFMP updates
- medication refills
- referral/consult requests
- Behavioral Health concerns
- URI symptoms in patients under the age of 4 months without a fever
- Rashes
- ER follow-ups
- Musculoskeletal injuries

Face-to-face Appointments
- Well-child checks in patients ages 2 and under
- Patients with fever persisting for more than 5 days
- Other patients as determined by providers during their Virtual/Tele Health appointment

Postponed Appointments
- Well-child checks in patients over the age of 2
- School/sports/CYS physicals

CHANGES TO SERVICE CAPABILITIES: There will be no walk-in immunizations or walk-in wart clinic. Vaccines for children under the age of 2 will be administered in conjunction with their scheduled well-child check to limit child/family exposure to the hospital, and to efficiently maximize our staffing capabilities.

PEDIATRIC SUBSPECIALTY CLINIC (GI, Neurology, Developmental)
CHANGES TO HOURS OF OPERATION: No change (7:30 a.m. - 4:30 p.m.)

CHANGES TO APPOINTMENTS: Pediatric Subspecialty Clinics will contact patients with appointments that are being deferred. The Clinics will continue as many appointments as possible via Virtual/Tele- Health appointments.

CHANGES TO SERVICE CAPABILITIES: All new referrals will be reviewed for appropriate evaluation.

PHARMACY
CHANGES TO HOURS OF OPERATION: No changes

CHANGES TO SERVICE CAPABILITIES: The pharmacy will continue operating as normal and beneficiaries will be updated via LRMC website/ social media of any future changes in schedules and capabilities. Patients are asked to use hand sanitizer before and after using QFlow kiosk. To safeguard patients, seating has been reduced by 50 percent and patients are asked not to rearrange seating for their safety. When called to the pharmacy windows, please scan your ID card rather than attempt to hand it to pharmacy staff.

PHYSICAL MEDICINE & REHABILITATION SERVICES
CHANGES TO HOURS OF OPERATION: No changes

CHANGES TO APPOINTMENTS: Appointments may be cancelled / rescheduled 1-2 days before scheduled appointment.

CHANGES TO SERVICE CAPABILITIES: Currently Active-Duty only. All cortical steroid injections, PRP injections and EMGs are suspended unless deemed necessary by medical providers.

PHYSICAL THERAPY
CHANGES TO HOURS OF OPERATION: No change

CHANGES TO APPOINTMENTS: Beneficiaries with changes to their appointments will be contacted directly, if no contact then patient should continue with scheduled appointments. If patients wish to cancel, they should contact the appointment line.

CHANGES TO SERVICE CAPABILITIES: Services reduced to 50 percent of normal workload. Patients are contacted by phone for virtual appointments if applicable. No new patients except for those with acute or post-operative needs. All other chronic conditions will resume when normal operations are resumed.

PULMONARY CLINIC
CHANGES TO HOURS OF OPERATION: No change.

CHANGES TO APPOINTMENTS: The Pulmonary Clinic staff are currently reviewing referrals and granting appointments on a case-by-case basis. Patients who already have appointments booked for March and April should expect to receive a phone call to reschedule. Care that cannot be postponed may be scheduled as a virtual / telehealth visit.

CHANGES TO SERVICE CAPABILITIES: Pulmonary function testing services are being granted on a case-by-case basis. Patients with scheduled pulmonary function tests should also expect to be contacted about rescheduling. All elective spirometry services are cancelled until further notice. Providers wishing to have spirometry performed on their patients can continue to place referrals or contact the clinic directly. Patients are encouraged to contact the LRMC Pulmonary Clinic at commercial: 06371-9464-5855, or DSN: 314-590-5855 if there are any questions or concerns.

SLEEP CLINIC
CHANGES TO HOURS OF OPERATION: No changes (7:30 a.m.-4 p.m.)

CHANGES TO APPOINTMENTS: As of Mar. 18, due to the high call volume on the LRMC signal network, all patients are being notified of appointment cancellations with a request to call back during the week of Mar. 23 to reschedule their sleep studies. The Sleep Clinic is operational with regular clinic hours; however, patients will have appointments conducted via Virtual or Telehealth unless deemed necessary to be seen face-to-face in the clinic. This is an effort to adhere to national recommendations for social distancing and decrease public exposure to COVID-19. We appreciate your understanding.

CHANGES TO SERVICE CAPABILITIES: : The Sleep Lab will be temporarily closed effective Mar. 22, 2020. Sleep studies will continue with home sleep testing being offered to most patients. When contacted by the Sleep Clinic for an at-home study, please download the one-page sleep intake questionnaire, which should be completed and emailed back to the Sleep Clinic at usarmy.landstuhl.medcom-rhc-e.mbx.sleep-lab@mail.mil.

SURGICAL CLINICS
CHANGES TO HOURS OF OPERATION: No changes

CHANGES TO APPOINTMENTS: As of March 20, Surgical Clinics will reduce capacity to evaluate patients with emergent and urgent issues, post-operative appointments, and conditions in moderate to severe stages where a delay would contribute to a degradation of condition. Priority for surgery will be for emergency or urgent surgery or in cases where delaying surgery longer than 30-60 days could contribute to a deterioration in health or a delay in diagnosis and treatment.

Definitions: Emergent: (needs to start within 1 hour of scheduling the surgery) Urgent: (needs to start within 6 hours of scheduling the surgery)

CHANGES TO SERVICE CAPABILITIES: Will attempt to conduct virtual health appointments where appropriate and when technology allows. For cancelled appointments and surgeries, patients will be notified by phone or email.

TBI CLINIC
CHANGES TO HOURS OF OPERATION: No change

CHANGES TO APPOINTMENTS: Patients with cancelled/ rescheduled appointments will be contacted via phone. Appointments will resume once normal operations are resumed.

CHANGES TO SERVICE CAPABILITIES: No new patients at this time, except deployed personnel and acute concussions referred from Emergency Department/ Primary Care Managers. All possible current patients may be seen via virtual health.

TRICARE SERVICE CENTER
CHANGES TO HOURS OF OPERATION: Monday - Thursday 7:30 a.m. to 4 p.m. and Friday 7:30 a.m. to 2 p.m.

CHANGES TO APPOINTMENTS: Office is closed to walk-in services. TRICARE Representatives will arrange for Face-to-Face appointments as necessary.

CHANGES TO SERVICE CAPABILITIES: Call 06371-9469-4830 to speak with a TRICARE representative Monday - Thursday 7:30 a.m. to 4 p.m. and Friday 7:30 a.m. to 2 p.m. TRICARE Representatives will arrange for Face-to-Face appointments as necessary.

LRMC TRICARE SERVICE CENTER: 06371-9464-4830 (DSN: 590-4830)
Customer Service Regional Direct: +(44) 20-8762-8384
Customer Service Toll Free: +(1) 800-589-1599
INTERNATIONAL SOS: 06102 35880
http://www.tricare-overseas.com