Systems Analysis of a Dedicated Ambulatory Respiratory Unit for Seeing and Ensuring Follow-up of Patients With COVID-19 Symptoms

Abstract

COVID-19 necessitated significant care redesign, including new ambulatory workflows to handle surge volumes, protect patients and staff, and ensure timely reliable care. Opportunities also exist to harvest lessons from workflow innovations to benefit routine care. We describe a dedicated COVID-19 ambulatory unit for closing testing and follow-up loops characterized by standardized workflows and electronic communication, documentation, and order placement. More than 85% of follow-ups were completed within 24 hours, with no observed staff, nor patient infections associated with unit operations. Identified issues include role confusion, staffing and gatekeeping bottlenecks, and patient reluctance to visit in person or discuss concerns with phone screeners.

Figure 1.

Cross-functional process map of the ARCCU-dedicated COVID-19 unit, showing patient triage, intake, visit, testing, and follow-up processes by location and personnel. ARCCU indicates Ambulatory Respiratory Cohorted Care Unit; CCA, clinical care assistant; ED, emergency department; PCP, primary care provider; PSR, patient service representative; PT, patient; QI, quality improvement.

Figure 2.

Longitudinal trends in ARCCU, telehealth, and in-person HCA episodic visits, April 15 to July 15, 2020. Left-hand figure: Total visit volume by type (dotted lines: 3-week moving average). Right-hand figure: Proportion of visits by type (dashed lines: statistical control limits, indicating statistical significance or stability. ARCCU indicates Ambulatory Respiratory Cohorted Care Unit; HCA, Healthcare Associates.