Pivoting in a Pandemic: Patient Care
Corona Virus Adrienne Davis holds a thermometer before taking a patient's temperature at the COVID-19 drive-thru. She is wearing PPE including a face mask, goggles, gloves and a medical gown. The patient's car is in the right of the frame of the photo.

Overcoming challenges on the frontlines of clinical care

As most people stayed home to avoid COVID-19, many EVMS Medical Group employees came to work each day to fight the virus on the frontlines. That fight required major changes to how they delivered healthcare.

“Responding to COVID-19 pushed the industry and our Medical Group to reengineer everything about how we provide medical care,” says Kurt Stauder, DPA, MBA, Chief Executive Officer for EVMS Medical Group. “Changes that would normally take years to evolve had to happen in a matter of weeks.”

While those changes were coming fast, Dr. Stauder says, “Keeping our patients, providers, staff, students and their families safe was, and continues to be, our number one priority.” The Medical Group engaged with leaders in patient safety and quality, medical directors and department heads to quickly develop a strategy to prepare for the pandemic.

Their plan included implementing a robust telehealth program, creating new policies about personal protective equipment (PPE) for patients and providers and developing a drive-thru testing system.

“In the first two weeks of the pandemic, we launched a fully operational telehealth platform,” says Alfred Abuhamad, MD, Vice Dean for Clinical Affairs. “Each receptionist was trained on how to transition future in-person appointments to telehealth when possible. This allowed many of our at-risk patients to continue their care from home.”

It also gave staff the opportunity to screen patients for symptoms of COVID-19, provide access to those with chronic conditions and ensure those who required medication were able to get it.

“EVMS students also helped us prepare patients for the transition,” says Margaret Baumgarten, MD, Quality Officer for EVMS Medical Group. “Several dozen medical students volunteered to contact patients, register them in our FollowMyHealth portal and help set up their preferences for telehealth.”

While telehealth was a change for patients, it also was a major shift for providers. Leaders held virtual training for staff and faculty on how to navigate the software, and they provided best practices for telehealth appointments.

Nikia Holley at Hofheimer Hall giving a thumbs up to a patient after screening the patient for COVID-19 symptoms. She is wearing a face mask, a partial face shield, medical gloves and a medical gown.
In the first days of the pandemic, just inside the entrance to Hofheimer Hall, Nikia Holley, Medical Assistant in EVMS Surgery, motions to a patient after screening her for COVID-19 symptoms.

“It’s gone very well and we are excited to use what we’ve learned beyond the pandemic,” Dr. Abuhamad says. “It will help us reach patients who are unable to get out of their homes due to illness, post hospitalization.”

New protocols keep patients and employees safe

As the pandemic spread around the world, it quickly became apparent that proper use of PPE could mean the difference between life and death. EVMS Medical Group again worked with leadership on how to safely manage patients and train staff, providers and residents in safety practices.

Their meetings led to several new protocols. First, patients would be required to wear masks when visiting the EVMS campus. Second, healthcare workers would be required to wear gloves, masks and eye protection when seeing patients. Third, all EVMS employees would be required to wear masks when on campus, even in non-clinical environments.

“To assist with the transition, we held regular meetings with department leaders to review PPE requirements and current protocols,” Dr. Abuhamad says. “We also created videos with infectious disease experts on the proper way to wear PPE and importance of wearing it at all times.”

With many new resident-doctors on staff, Graduate Medical Education also created a public service announcement targeting residents to ensure they were aware of each requirement.

In addition to protecting patients through PPE, several measures were put into place to encourage social distancing in clinical settings, including health screenings for patients at building entrances, plexiglass barriers at reception areas and signage to advise visitors to stay at least six feet apart.

To ensure cleanliness of facilities, Dr. Baumgarten says the number of housekeeping staff was expanded. “Crews were assigned to clean patient-care rooms and instruments after each patient visit, as well as common areas.”

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It is important for our trained professionals to continue to mask, distance and use the same critical thinking that keeps them safer at work while at home and living our daily, but changed, lives.

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Kurt Stauder, DPA, MBA

Dr. Stauder says the safety protocols have been effective. He congratulates the Medical Group team and proudly notes that as of July 29, the date of his interview, “We have not had a known transfer or contraction resulting in an exposure or cluster in our ambulatory practice.”

Despite the inherent dangers of their jobs, Dr. Stauder says the greatest exposure risk for Medical Group employees hasn’t been in the clinics but in the community. “It is important for our trained professionals to continue to mask, distance and use the same critical thinking that keeps them safer at work while at home and living our daily, but changed, lives.”

When someone in the Medical Group workforce does test positive, Human Resources, Operations and Occupational Health and the Quality and Safety Leadership team have a process in place to track reporting, testing, sequestration and eventually a return to work.

Drive-thru testing was top priority

One of the most important strategies to minimize exposure for patients was the creation of a drive-thru testing facility for those with symptoms of the virus.

“It was one of the first things our leadership team put into place,” Dr. Abuhamad says. “Those who meet the requirements are evaluated, tested and then receive education about next steps until they receive their results.”

The drive-thru testing program was set up in a parking garage on campus and primarily staffed by the EVMS Quality Office with the help of physicians and staff from Family and Community Medicine and Internal Medicine.

While obtaining timely test results has been challenging, leaders say the program has been successful. “We’ve had great communication with those who have been tested,” Dr. Baumgarten adds, “and we have been able to quickly trace and find potential exposures to protect staff and patients.”

“Proud does not begin to describe how we feel about the amazing teamwork each department within the Medical Group has displayed during this crisis,” Dr. Stauder says.

“Many of our employees have put themselves in danger’s way and faced extreme adversity, but they have persevered. We will be a stronger institution thanks to their hard work.”

ALFRED ABUHAMAD

ALFRED ABUHAMAD, MD

Dr. Abuhamad is the Mason C. Andrews Chair in Obstetrics and Gynecology, Vice Dean for Clinical Affairs and Professor and Chair of Obstetrics and Gynecology.

MARGARET BAUMGARTEN

MARGARET BAUMGARTEN, MD

Dr. Baumgarten (Family Medicine Residency ’99) is the Charles F. Burroughs Jr. Chair in Family and Community Medicine, Professor of Family and Community Medicine and Quality Officer for EVMS Medical Group.