Setting up an outdoor clinic for COVID-19: key steps

In response to the novel coronavirus pandemic, Eglin Family Medicine Residency Clinic (FMRC), located in Eglin Air Force Base, Fla., set up an outdoor clinic in its parking lot to deliver face-to-face care to patients with suspected COVID-19. The outdoor clinic helped relieve stress on the emergency department and made efficient use of staff and personal protective equipment (PPE), while limiting the spread of infection.

Four steps were key to the outdoor clinic’s success.

1. Triaging patients for virtual visits, office visits, or outdoor visits.

Almost all visits to Elgin FMRC were conducted virtually, including chronic disease management. Only patients who required a physical exam for appropriate medical care were sent to the clinic for a face-to-face visit. If the patient was not deemed an infection risk, the face-to-face visit occurred inside the clinic. But if the patient was deemed an infection risk, either because of COVID-19 or other infectious disease symptoms, the face-to-face visit occurred at the outdoor clinic.

2. Identifying “cold,” “warm,” and “hot” zones to mitigate contamination.

“Hot” or contaminated zones included the tents where patients parked and were treated and where staff stored, donned, and disposed of full PPE. The “warm” or support zone included a tent where staff members who weren’t working directly with patients cleaned and disinfected equipment. Staff in this zone wore surgical masks, scrubs, and disposable gloves. The “cold” or clean zone was inside the clinic, where residents and staff provided virtual support, without a need for PPE.

3. Creating a clear workflow.

Prior to the outdoor visit, a physician working inside the clinic would take the patient’s history over the phone, in order to limit the face-to-face interaction at the outdoor clinic, and would direct the patient to the outdoor clinic for physical examination and subsequent care. A physician staffing the outdoor clinic would discuss the patient’s history by cellphone or two-way radio with the physician who conducted the virtual part of the encounter, and then evaluate the patient in the vehicle, or occasionally outside the vehicle, and determine appropriate testing, medications, referral to the emergency department, etc. If medication needed to be dispensed, the outdoor team dispatched a runner from the cold zone inside the clinic to pick up the medication at the on-site pharmacy and deliver it to the warm zone. A medical assistant wearing a surgical face mask would stand more than six feet away and serve as a scribe. After the face-to-face evaluation, the outdoor physician used the scribe’s notes to relay physical exam findings and treatment information via cellphone or two-way radio to the physician working inside the office, who completed charting and wrote any necessary orders. When patients were tested for COVID-19, clerks scheduled follow-up telehealth appointments to discuss results.

4. Having the right equipment and supplies.

The outdoor clinic required battery-powered vital sign machines; canopy tents to shelter staff and patients from the weather; appropriate PPE for both hot and warm zones; medications readily available to dispense to patients; and appropriate testing supplies (COVID-19, strep, polymerase chain reaction (PCR) influenza, respiratory panel, etc.). If patients needed additional diagnostic tests such as an electrocardiogram or X-ray, patients were masked and escorted directly to an available exam room inside the clinic.

Read the full FPM article: “Building an Outdoor Urgent Care Clinic During a Pandemic: One Clinic’s Experience.”