- In advance of the COVID-19 outbreak in Boston, Massachusetts General Hospital created a Surge Clinic to relieve strain on emergency department (ED) resources
- All patients arriving at the ED without an appointment are evaluated by a nurse who determines whether they should go to the ED or the clinic
- About 75% of patients who come to the clinic have appointments scheduled through referrals from primary care offices, triage phone lines or the hospital's occupational health service
- During its first three weeks of operation, the clinic saw 2,667 patients (average = 160 daily) and only about 1% required transfer to the ED
In advance of the COVID-19 outbreak in Boston, Massachusetts General Hospital created a Surge Clinic in its indoor ambulance bay to relieve strain on emergency department (ED) resources. Joshua J. Baugh, MD, MPP, physician in the Department of Emergency Medicine, and Paul D. Biddinger, MD, chief of the Division of Emergency Preparedness and director of the Center for Disaster Medicine at Massachusetts General Hospital, and colleagues describe the clinic in The American Journal of Emergency Medicine.
All patients arriving at the ED are given masks and evaluated by a nurse who asks about COVID-related symptoms and determines which patients are appropriate for the clinic versus the ED. Patients excluded from the Surge Clinic are those with:
- Chest pain
- Shortness of breath
- Significant comorbidities such as immunocompromising illness, significant pulmonary conditions or end-stage organ disease
Vital signs are obtained only if deemed necessary for assessing stability for the clinic.
About 75% of patients who come to the clinic have appointments scheduled through referrals from primary care offices, triage phone lines or the hospital's occupational health service. They proceed directly to the clinic on arrival.
The Surge Clinic registration desk is located six feet from the patient arrival area with a physical barrier to protect registration personnel and limit their need for personal protective equipment. Waiting room chairs are placed six feet apart and are cleaned by environmental services staff between patients. A nurse monitors the waiting area and patient flow.
Evaluation and Discharge
The clinic has four clinical spaces separated by temporary plastic walls and three portable restrooms with a handwashing station for patients.
Evaluation is performed by two clinicians, generally a physician and an advanced practitioner. One performs the history and physical; the other documents the encounter and orders any laboratory tests needed while standing at a computer six feet away. The tests available are influenza/respiratory syncytial virus, strep and COVID-19. A nurse collects specimens as needed and the patient is sent to the discharge area.
The clinicians then clean their area, doff and don PPE for the next patient. This workflow minimizes the amount of PPE used per patient.
In the discharge area, a nurse provides education about in-home self-isolation and the plan of care. The patient then receives a discharge packet, which includes a mask for travel home and an additional mask in case the patient needs to return for further evaluation.
During its first three weeks of operation, the Surge Clinic saw 2,667 patients (average = 160 daily). Only about 1% required transfer to the ED for further testing or treatment.
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