We Built a Primary Care Respiratory Clinic. Here’s How It Works
By Craig McDougall, Timothy Joslin, Daisuke Yamashita, Andy Barnett, Bruin Rugge, Jennifer DeVoe
Note: Oregon Health and Science University patients are advised to consult the official OHSU COVID-19 page.
In early 2020 when the COVID-19 pandemic hit the United States, many primary care teams across the country faced the need to cohort patients and adhere to strict physical distancing recommendations. Many non-urgent appointments were postponed, and most other visits were shifted from being done in person to happening via telephone, video, or email visit. Yet, there was an acute need to see an influx of patients with respiratory symptoms who potentially had COVID-19 and could be highly contagious to all patients, clinicians and staff in a traditional clinic setting. Thus, new “Respiratory Clinics” were created.
At Oregon Health & Science University (OHSU), we worked swiftly and effectively to respond to the COVID-19 crisis and build a Primary Care Respiratory Clinic. The clinic was built “from scratch” by dozens of people across multiple departments and the multiple division in the medical center working around the clock, and in less than one week.
It highlights how primary care departments and the administration have come together at OHSU in a collaborative spirit in this time of urgency and includes clinicians from Family Medicine, Internal Medicine, Immediate Care, and the Center for Women’s Health to staff the clinic.
This new respiratory clinic opened April 7, 2020. The goal is to prevent patients who suffer from fever, cough, shortness of breath and other respiratory symptoms from coming to OHSU’s other primary care clinics, where they might spread COVID-19 to other primary care patients.
Those who have symptoms suggesting possible COVID-19 infection will be scheduled by either calling into the OHSU COVID 19 Connected Care Center or through their PCP or specialty care clinician after an RN has triaged the patient for severity.
Those who have moderate symptoms are then scheduled with PCP or primary care clinician on their team for a virtual visit (via phone or video). After the virtual visit the patient may then be scheduled into the respiratory clinic for an in-person assessment if needed.
Patients who do not have PCPs within OHSU’s system and access our Immediate Care clinics are also able to schedule appointments. The respiratory clinic location was chosen to allow easy and direct access to a back door entrance near adjacent exam rooms.
Patients are met by clinical staff in the parking area who provide them with a mask and other necessary PPE prior to entry into the building. Triage is completed by an RN prior to entering the facility, with portable pulse oximetry.
Patients are cohorted by severity, and are then escorted to a room by an MA. COVID-19 testing and portable x-ray are readily available at the clinic, and the clinic is located across the street from the emergency department (ED) in case rapid transport to the ED is needed. Having a dedicated destination for those with suspicion of COVID-19 infection allows our other primary care clinic locations to remain open to provide care for patients with chronic and acute illnesses — not to mention pre-natal and well child visits — without high risk of contamination or spread of infection from COVID-19 patients.
Various workflows and documents have been created that map out the process and implementation for getting this clinic up and running. OHSU’s respiratory clinic is just one example of many across the country and is one element in a comprehensive primary care approach to address the needs of our patients and communities during the COVID-19 pandemic.
We have included links to many documents supporting the OHSU respiratory clinic. Though specific to certain conditions at OHSU, many of these materials could be adopted by other healthcare systems.
- OHSU Primary Care Respiratory Clinic Protocols (.PDF)
- OHSU Formulary for PPV PCRC (.XLSX)
- OHSU Respiratory Clinic Workflow (.PDF)
- OHSU’s Guidance for COVID-19 Testing in the Emergency and Ambulatory Settings (.PDF)
- OHSU Primary Care clinical guide for in-person evaluation of the patient with symptomatic COVID 19 or patient under investigation for COVID 19 (.DOCX)
Authors: Craig S McDougall, MD; Timothy A Joslin, MD; Daisuke Yamashita, MD; Andy Barnett, MD; Bruin Rugge, MD; Jennifer DeVoe, MD, DPhil; Oregon Health and Science University
