Operationalizing a Pandemic-Ready, Telemedicine-Enabled Drive-Through and Walk-In Coronavirus Disease Garage Care System As an Alternative Care Area: A Novel Approach in Pandemic Management

Overview

Journal J Emerg Nurs

Specialties Emergency Medicine
Nursing

Date 2021 Jul 25

PMID 34303530

Citations 3

Authors

Patrice Callagy

Shashank Ravi

Saud Khan

Maame Yaa A B Yiadom

Hannah McClellen

Samual Snell

Thomas W Major

Maria Yefimova

Affiliations

Soon will be listed here.

Abstract

Objective: Emergency departments face unforeseen surges in patients classified as low acuity during pandemics such as the coronavirus disease pandemic. Streamlining patient flow using telemedicine in an alternative care area can reduce crowding and promote physical distancing between patients and clinicians, thus limiting personal protective equipment use. This quality improvement project describes critical elements and processes in the operationalization of a telemedicine-enabled drive-through and walk-in garage care system to improve ED throughput and conserve personal protective equipment during 3 coronavirus disease surges in 2020.

Methods: Standardized workflows were established for the operationalization of the telemedicine-enabled drive-through and walk-in garage care system for patients presenting with respiratory illness as quality improvement during disaster. Statistical control charts present interrupted time series data on the ED length of stay and personal protective equipment use in the week before and after deployment in March, July, and November 2020.

Results: Physical space, technology infrastructure, equipment, and staff workflows were critical to the operationalization of the telemedicine-enabled drive-through and walk-in garage care system. On average, the ED length of stay decreased 17%, from 4.24 hours during the week before opening to 3.54 hours during the telemedicine-enabled drive-through and walk-in garage care system operation. There was an estimated 25% to 41% reduction in personal protective equipment use during this time.

Conclusion: Lessons learned from this telemedicine-enabled alternative care area implementation can be used for disaster preparedness and management in the ED setting to reduce crowding, improve throughput, and conserve personal protective equipment during a pandemic.

Citing Articles

Patient flow management in biological events: a scoping review.

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Effectiveness, safety, and efficiency of a drive-through care model as a response to the COVID-19 testing demand in the United States.

Ravi S, Graber-Naidich A, Sebok-Syer S, Brown I, Callagy P, Stuart K J Am Coll Emerg Physicians Open. 2022; 3(6):e12867.

PMID: 36570369 PMC: 9767858. DOI: 10.1002/emp2.12867.

Implementing a COVID-19 Virtual Observation Unit in Emergency Medicine: Frontline Clinician and Staff Experiences.

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References

Bauchner H, Fontanarosa P, Livingston E . Conserving Supply of Personal Protective Equipment-A Call for Ideas. JAMA. 2020; 323(19):1911. DOI: 10.1001/jama.2020.4770. View

Candel B, Vaes S, van Bree E, Groenen S, Derkx F, Mignot L . Telemedicine in the emergency department to decrease personal protective equipment use: a before-and-after study. Emerg Med J. 2020; 38(3):224-228. DOI: 10.1136/emermed-2020-210292. View

Speroff T, OConnor G . Study designs for PDSA quality improvement research. Qual Manag Health Care. 2004; 13(1):17-32. DOI: 10.1097/00019514-200401000-00002. View

Wittbold K, Baugh J, Yun B, Raja A, White B . iPad deployment for virtual evaluation in the emergency department during the COVID-19 pandemic. Am J Emerg Med. 2020; 38(12):2733-2734. PMC: 7165114. DOI: 10.1016/j.ajem.2020.04.025. View

Russi C, Heaton H, Demaerschalk B . Emergency Medicine Telehealth for COVID-19: Minimize Front-Line Provider Exposure and Conserve Personal Protective Equipment. Mayo Clin Proc. 2020; 95(10):2065-2068. PMC: 7425764. DOI: 10.1016/j.mayocp.2020.07.025. View

Bains J, Greenwald P, Mulcare M, Leyden D, Kim J, Shemesh A . Utilizing Telemedicine in a Novel Approach to COVID-19 Management and Patient Experience in the Emergency Department. Telemed J E Health. 2020; 27(3):254-260. DOI: 10.1089/tmj.2020.0162. View

Whiteside T, Kane E, Aljohani B, AlSamman M, Pourmand A . Redesigning emergency department operations amidst a viral pandemic. Am J Emerg Med. 2020; 38(7):1448-1453. PMC: 7156950. DOI: 10.1016/j.ajem.2020.04.032. View

Rathlev N, Chessare J, Olshaker J, Obendorfer D, Mehta S, Rothenhaus T . Time series analysis of variables associated with daily mean emergency department length of stay. Ann Emerg Med. 2007; 49(3):265-71. DOI: 10.1016/j.annemergmed.2006.11.007. View

Jeffery M, DOnofrio G, Paek H, Platts-Mills T, Soares 3rd W, Hoppe J . Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA Intern Med. 2020; 180(10):1328-1333. PMC: 7400214. DOI: 10.1001/jamainternmed.2020.3288. View

10.

Wallace D, Burleson S, Heimann M, Crosby J, Swanson J, Gibson C . An adapted emergency department triage algorithm for the COVID-19 pandemic. J Am Coll Emerg Physicians Open. 2020; 1(6):1374-1379. PMC: 7436476. DOI: 10.1002/emp2.12210. View

11.

McHugh M, Tanabe P, McClelland M, Khare R . More patients are triaged using the Emergency Severity Index than any other triage acuity system in the United States. Acad Emerg Med. 2012; 19(1):106-9. DOI: 10.1111/j.1553-2712.2011.01240.x. View

12.

Paganini M, Conti A, Weinstein E, Della Corte F, Ragazzoni L . Translating COVID-19 Pandemic Surge Theory to Practice in the Emergency Department: How to Expand Structure. Disaster Med Public Health Prep. 2020; 14(4):541-550. PMC: 7156581. DOI: 10.1017/dmp.2020.57. View

13.

Ahmed S, Sanghvi K, Yeo D . Telemedicine takes centre stage during COVID-19 pandemic. BMJ Innov. 2023; 6(4):252-254. DOI: 10.1136/bmjinnov-2020-000440. View

14.

Weiss E, Ngo J, Gilbert G, Quinn J . Drive-through medicine: a novel proposal for rapid evaluation of patients during an influenza pandemic. Ann Emerg Med. 2010; 55(3):268-73. DOI: 10.1016/j.annemergmed.2009.11.025. View

15.

Sun B, Hsia R, Weiss R, Zingmond D, Liang L, Han W . Effect of emergency department crowding on outcomes of admitted patients. Ann Emerg Med. 2012; 61(6):605-611.e6. PMC: 3690784. DOI: 10.1016/j.annemergmed.2012.10.026. View

16.

Callagy P, Woodfall M . Drive-through triage and care system: lessons learned from a pandemic drill. J Emerg Nurs. 2009; 35(6):588-93. DOI: 10.1016/j.jen.2009.09.010. View

17.

Boyle A, Henderson K . COVID-19: resetting ED care. Emerg Med J. 2020; 37(8):458-459. PMC: 7418608. DOI: 10.1136/emermed-2020-210282. View

18.

Morley C, Unwin M, Peterson G, Stankovich J, Kinsman L . Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One. 2018; 13(8):e0203316. PMC: 6117060. DOI: 10.1371/journal.pone.0203316. View

19.

Mehrotra P, Malani P, Yadav P . Personal Protective Equipment Shortages During COVID-19-Supply Chain-Related Causes and Mitigation Strategies. JAMA Health Forum. 2022; 1(5):e200553. DOI: 10.1001/jamahealthforum.2020.0553. View

20.

Schwedhelm M, Herstein J, Watson S, Mead A, Maddalena L, Liston D . Can You Catch It? Lessons Learned and Modification of ED Triage Symptom- and Travel-Screening Strategy. J Emerg Nurs. 2020; 46(6):932-940. PMC: 7160057. DOI: 10.1016/j.jen.2020.03.006. View