Building an Outdoor Urgent Care Clinic During a Pandemic: One Clinic's Experience
When an infectious disease outbreak strikes, an outdoor clinic can reduce the risk of transmission and conserve personal protective equipment.
Fam Pract Manag. 2020 Sep-Oct;27(5):14-19.
Author disclosures: no relevant financial affiliations disclosed.
When the COVID-19 outbreak in the United States was declared a national emergency on March 1, family medicine practices had to quickly adapt their workflows to continue providing essential care while limiting the spread of infection. Our clinic, Eglin Family Medicine Residency Clinic (FMRC), responded to the pandemic's challenges in a way that is instructive for the current crisis and future infectious disease outbreaks: by establishing a drive-in outdoor clinic for testing and treating suspected infections.
Eglin FMRC is a 36-resident program with 12 core faculty members, nestled in a small military community hospital in northwest Florida. Our primary goal as a health system during the pandemic was to decrease patient flow through our main building, while preparing for an expected inpatient surge and continuing to meet outpatient needs. We decided early on to create an outdoor urgent care unit to evaluate potentially infectious patients.
Other clinics have published information about performing outdoor care pre-COVID-19, but few have published detailed instructions on how to set up an outdoor clinic.1 A systematic review of 13 articles identified effective practices and recommendations for drive-through clinics to dispense mass prophylaxis during public health emergencies, but these articles were mainly based on simulations.2 This article documents some practical processes, policies, and workflows implemented during a real-life emergency, which other institutions may find useful when the next infectious outbreak occurs.
A drive-in clinic allows physicians to evaluate patients with symptoms of an infectious disease without exposing other patients or staff. It also reduces the need for surface cleaning between visits.
Separating the outdoor clinic into “cold,” “warm,” and “hot” zones using hazardous materials protocols helps preserve personal protective equipment while reducing transmission risk.
Climate and staffing are factors that could limit the ability to establish a full outdoor clinic, but even small practices may be able to adapt some of the principles for occasional outdoor patient visits.
SETTING UP THE CLINIC
Our hospital leadership designated some parts of the hospital “noninfectious” and others “infectious.” Patients who screened positive for any COVID-19 symptoms would be seen in the infectious areas, which included the FMRC, emergency department (ED), and inpatient wards. Personnel in these areas needed to prepare to maintain a high degree of capability despite expected staff absences. To that end, FMRC devised a drive-in clinic to efficiently utilize limited staff, personal protective equipment (PPE), and facilities while delivering face-to-face care to patients suspected of being infectious. This drive-in, appointment-based, urgent care
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1. Church SL. The parking lot visit: how it works. FPM online. March 25, 2020. Accessed July 21, 2020. https://www.aafp.org/journals/fpm/blogs/inpractice/entry/parking_lot_clinic.html...
2. Buck BH, Cowan L, Smith L, Duncan E, Bazemore J, Schwind JS. Effective practices and recommendations for drive-through clinic points of dispensing: a systematic review. Disaster Med Public Health Prep. April 1, 2020:1-15
3. Decontamination procedures. Chemical Hazards Emergency Medical Management (CHEMM), U.S. Department of Health and Human Services. April 17, 2020. Accessed July 21, 2020. https://chemm.nlm.nih.gov/decontamination.htm
4. Chan KH, Malik Peiris JS, Lam SY, Poon LLM, Yuen KY, Seto WH. The effects of temperature and relative humidity on the viability of the SARS coronavirus. Adv Virol. 2011:734690
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