Developing a COVID-19 Acute Respiratory Care Clinic in 5 Days
Reception staff, medical assistants, nurse practitioners, physicians, and the administrators working together to get our patients the help they need.
On March 11, 2020 the first confirmed case of COVID-19 was diagnosed in Rochester, NY.
In response to this, our practice initiated an “Acute Respiratory Suite” five days later.
Our practice, a training site for 36 Family Medicine residents and fellows, and 2 Nurse Practitioner residents, sees a total of 70,000 visits a year; we offer walk-in visits 6 days a week. Even as our staff and clinicians were actively transitioning the most of our visits to telemedicine, we had many patients walking in with respiratory symptoms.
With the goal of infection prevention and quality care, we designated one of our clinical suites for “Acute Respiratory Care.” We implemented entrance screening for all staff and patients, masking any patients who screened positive for the following: fever, cough, dyspnea, body aches, or sore throat. Staff escorted these individuals directly to the “Acute Respiratory Suite” contiguous with the entrance.
The goal of this suite is 3-fold:
1. Triage patients who needed further hospital support from patients who can continue supportive care at home.
2. Counsel patients on what we understand so far about COVID-19, including disease-prevention precautions, self-quarantine guidelines, and direct them to other evidence-based educational resources.
3. Provide testing for patients suspected of having COVID-19 based on exposures and/or symptoms, and who are at higher for disease transmissibility, e.g. healthcare workers and residents of assisted living facilities or group homes.
This suite is staffed during all open clinical time. Here is our clinical algorithm for staff and clinicians, with a brief explanation of the algorithm below.:
1. All patients and staff are screened for infectious symptoms and a temperature, by trained staff wearing PPE at the entrance of the practice.
2. Any patient who screens positive is provided a surgical mask and escorted to the Acute Respiratory Suite.
3. To minimize the person-to-person contact, the clinician — instead of the MA — takes the patient’s vitals in addition the HPI and physical exam.
4. Clinicians staffing the suite use gloves and surgical masks when interacting with patients. If the decision is made to remove the patient’s surgical mask to test a patient for COVID-19, the clinician would first exit the room to don the additional PPE of a paper gown and a shielded face mask.
5. After obtaining the deep nasopharyngeal and completing the visit, the clinician doffs the PPE.
Implementing this process occurred in tandem with daily updates from our County Department of Public Health and University leadership. Universal masking of staff went into effect two weeks into the process.
Our first author is the senior resident who was initially assigned to the Acute Respiratory Clinic, and worked closely with practice leadership to respond to county and university guidance, and add to our protocols in real time.
One of the most enduring images we hold is not of the tense faces behind surgical masks as we faced our first day of uncertainty in Respiratory Walk-In clinic, but rather of the reception staff, the medical assistants, the nurse practitioners, the physicians, and the administrators who banded together to create a team to get our patients the help they need.
Medical assistant and nursing staff both as the “door screening” team and the “acute respiratory team” demonstrated flexibility, grace, and leadership in adapting to the new protocol, and training others as they rotated into this clinical program.
Rachel Bian, MD, Third Year Family Medicine Resident
Highland Hospital/University of Rochester Family Medicine Residency Program
Mathew Devine, DO, Medical Director, Highland Family Medicine, Associate Professor of Family Medicine
Colleen T. Fogarty, MD, M.Sc., William Rocktaschel Professor and Chair, University of Rochester Department of Family Medicine
