Patient Perceptions of Drive-Through Medical Treatment Facilities During the COVID-19 Pandemic

Sean Stuart, DO, LCDR, MC, USN; Sally Mandichak, MD, LT, MC, USN; Julianne Davison, MD, LT, MC, USN; Shai Ansell, MD, LT, MC, USN; Timothy Parker, MD, LT, MC, USN

Disclosures

Western J Emerg Med. 2021;22(5):1032-1036. 

In This Article

Methods

Naval Medical Center Portsmouth (NMCP) is a 298-bed federal, academic hospital with nine branch clinics and an ED census of 86,000 annually. In response to the COVID-19 pandemic, NMCP's ED established a DMEF in proximity to the ED. All adult patients presenting to the ED with symptoms of potential COVID-19 etiology and deemed non-critical were directed to the DMEF for initial evaluation.

Drive-through Medical Treatment Facility Logistics

The DMEF was designed to allow full evaluation, dispositioning and treatment of outpatient patients with potential COVID-19 symptoms. It was staffed Monday through Saturday, 9 AM – 4 PM, by an emergency physician who oversaw up to four advanced practice providers (APP), each with a corpsman (medical assistant) and one nurse per APP pair. The facility consisted of three 40' × 50' temporary shelters erected in a parking lot adjacent to the ED. These structures allowed patients to drive their vehicles through, and the entire medical process was handled while the patients remained in their vehicles. On arrival patients were screened by a triage nurse using a pre-made screening form to determine appropriateness for DMEF evaluation vs diversion to the main ED. If appropriate, the patient was then registered, vital signs were recorded, and a paper medical chart was prepared. The patients then drove forward to a treatment station where a history and physical exam were conducted. Select point-of-care testing for COVID-19, influenza, and group B strep were also available. Upon completion of the evaluation and disposition, the standard discussion of diagnosis, treatment and follow-up plans occurred aided by preprinted discharge forms. Select medications including antipyretics and common "cold medications" formulations (guaifenesin, dextromethorphan, etc) were available for immediate dispensing, with traditional paper prescriptions used for other indicated medications.

Patient Perceptions

We developed a three-part questionnaire to evaluate patient perceptions of a drive-through medical system. The questionnaire was piloted with a small group of professionals (two physicians, two nurses, two administrative personnel) to ensure clarity of the survey questions. To optimize feasibility and participation, the final questionnaire was limited to five questions, each using a five-point Likert scale. (Figure 1). Three questions pertained to perceptions of components of their care (clinician evaluation, explanation, and level of care delivered), one assessed convenience, and one the overall impression of the use of drive-through systems for medical evaluation. An optional free-response section was included to allow participants to provide additional comments.

Figure 1.

Patient perception survey of a drive-through medical evaluation system.

All patients completing medical evaluation at the NMCP's DMEF were eligible to participate in the study. We excluded from participation any patients sent to the ED for further evaluation by DMEF providers. A convenience sample of patients from May 1–July 1, 2020 between 8 AM – 4 PM were offered the opportunity to participate anonymously in the survey to evaluate their experience following their medical evaluation. Participants completed the survey via a provided electronic tablet. We examined all the data obtained and coded the responses. The data was then descriptively analyzed, and an appropriate test was applied in Excel (Microsoft Corp., Redmond, WA).

processing....