Improving Patient Care and Safety during COVID-19: A Note from Patrice Callagy

Prepared for Disaster: How Drive-Though Treatment Garages Improved Emergency Care

As the Executive Director of Stanford Health Care (SHC) Emergency Services, I’ve been immersed in making sure SHC continues to provide best-in-class healthcare, preserve public confidence in us, and maintain staff and patient safety throughout the COVID-19 pandemic.

Fortunately, SHC regularly conducted disaster simulations with both our pediatric and adult Emergency Departments (EDs) which include infectious agents.  Because of our commitment to preparedness, we were poised to deal with the initial surge in patients at the EDs that was associated with an evolving, worldwide pandemic.

Strong, interdisciplinary working relationships between the various departments is one of our strengths, as is adaptability and innovation. Because these foundations were already deeply ingrained in our core, we were able to quickly meet the many, various demands of the COVID-19 pandemic.  Key to our success was the seamless working relationships between ED nursing.

MD leadership and staff. All of this was put to the test in the early days of the pandemic when, as an example, we needed robust protocols to safely, efficiently and effectively identify and segregate potential COVID-19 patients from non COVID-19 patients seeking emergency care. My role included forming multiple, interdisciplinary committees as we met the workflow and practice challenges caused by COVID-19.

I was pleased that SHC and other healthcare facilities relied on a 2009 publication I co-authored about a drive-through treatment garage, and SHC’s disaster simulation that validated the feasibility of the drive-through treatment garage.  Our 2009 simulation demonstrated that a drive-through treatment garage could be quickly implemented during a pandemic to segregate patients, increase social distancing and increase capacity to meet patient surges.  At the beginning of COVID-19, I fielded numerous calls from other healthcare facilities wanting to implement a drive-through treatment garage or something similar. Lessons learned in that 2009 simulation enabled us to safely implement a COVID-19 garage drive-through care area within just 12 hours of identifying an increase in our ED patients.  Because of our early preparation for the garage drive-through system, patients presenting to our ED remained safely in their cars while a nurse provided the triage, treatment and care, and an ED physician provided a telemedicine video visit.  Our drive-through treatment garage enabled us to reduce the length of stay to an average of 25 minutes for the patients seen through the garage care area, which significantly increased patient throughput at a time when we were experiencing significant patient surges.

I’m most proud of our commitment to our employees to keep them safe. Every hour of every day I saw our employees working tirelessly to help others through this crisis. We demonstrated our commitment to their safety and its success by testing all hospital employees and medical staff for COVID-19 as well as COVID-19 antibodies.

I have complete confidence in the hospitals and emergency rooms around the country and want patients to feel safe to return to them for emergency care.  However, patients should expect that ED visits will be different from previous, pre-COVID visits.  For example, upon arrival at a SHC ED, a patient will be screened and have a temperature check by a nurse prior to entering the ED. All staff, patients and their one ED visitor will be required to wear a surgical mask, and if there is a wait, there will be multiple, segregated waiting areas to promote social distancing.  Also, at the SHC EDs, the majority of patients will receive a COVID test and will have a result within 2 hours.  I expect the same or similar protocols are in place at other EDs. While some of this may sound inconvenient, it will ensure that EDs are safe and uphold public confidence in its healthcare system.