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

Abstract

Objective: Emergency departments (ED) face unforeseen surges in low-acuity patients during pandemics, such as COVID-19. Streamlining patient flow using telemedicine in an alternative care area can reduce overcrowding and promote physical distancing between patients and clinicians, thus limiting personal protective equipment (PPE) 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 (Tele-Garage) to improve ED throughput and save PPE during three COVID-19 surges in 2020. Method: Standardized workflows were established for the operationalization of the Tele-Garage for patients presenting with respiratory illness. Statistical control charts present interrupted time series data on the ED length of stay (ED-LOS) and PPE 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 Tele-Garage. On average, ED-LOS decreased 17%, from 4.24 hours during the week prior to opening to 3.54 hours during Tele-Garage operation. There was an estimated 25-41% reduction in PPE use during this time. Conclusion: Lessons learned from this effective telemedicine-enabled alternative care area implementation can be used for disaster preparedness and management in the ED setting to reduce overcrowding, improve throughput, and conserve PPE during a pandemic.

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

“…ED and hospital leadership identified an area within a nearby garage that was converted into a care unit. Details of the care model's development and early launch have been previously published 8,9 …”

“…Curbside screeners were placed outside of the ED in full PPE that consisted of a gown, N95 mask, gloves, and disposable goggles. 8 Ambulatory ED patients, including those arriving in private vehicles, public transportation, or on foot to the ED were directed to the curbside screeners as the first point of contact. The screening staff asked each arriving patient if they were experiencing fever, cough, sore throat, or shortness of breath.…”

“…In this investigation, we share our experience launching this intervention in the early phases of the pandemic and quality‐related outcomes 8 …”

Changing Behaviors: The Behavior Change Wheel and Emergency Nursing

“…27 Environmental/ social planning Designing, changing, or regulating the physical or social context Using a parking garage space, the triage and screening of patients with respiratory presentations was physically redesigned into a telemedicine-enabled drive-through system for patients with respiratory presentations to lower exposure risks to coronavirus disease. 28…”

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

“…Examples of these tools included the iPad deployment for virtual evaluation, virtual rounding, remote patient monitoring (RPM), and a hotline for COVID-19 screening ( Jaffe et al, 2021 ; Uscher-Pines et al, 2021 ). Indeed, the adoption of such tools—within the ED and post-ED discharge—allowed facilities to conserve personal protective equipment (PPE; Bains et al, 2021 ; Callagy et al, 2021 ; Candel et al, 2021 ; Hamm et al, 2020 ), increase attention to staff safety ( Bains et al, 2021 ), and improve throughput ( Callagy et al, 2021 ; Chou et al, 2020 ). As uses of digital technologies continue even as the pandemic subsides ( “Telehealth Is Here to Stay,” 2021 ), it is important to understand how their implementation affects care delivery processes as well as the interface between patients and health care professionals.…”