Seeing A Need, Meeting A Need

High volumes and the continuing pandemic are causing system stress and fatigue for many. Our emergency departments are seeing a lot of patients. The question was asked, what can we do to relieve some of this stress in the ED?

One solution is the Minor Illness Clinic (MIC) at Liberty and Burnet Campuses.

“ED volumes have just been unprecedented with lots of upper respiratory illness and significant demand on top of some really tough staffing challenges,” said Carrie Romano, DNP, RN, assistant vice president, Patient Services. “Patients and families were experiencing significant waits in the emergency departments, and several of us started recognizing that we were at a critical juncture and identified other models of care in the community.”

It started with three goals:

  • Decompress the ED by shifting lower acuity patients to the appropriate level of care
  • Decrease cost of care for patients
  • Help mitigate ED system stress

“If we can move them quickly through a clinic environment, it serves a couple of purposes,” said Romano. “We improve the patient/family experience. We also mitigate some of that crowding that we have in the ED waiting rooms with kids who are potentially high-risk, symptomatic patients, right next to others who are not very sick but are exhibiting COVID-19 symptoms.”

We are already seeing the wisdom of this approach.

“One day we had 20 patients between noon and 1 pm," said Romano. "We took 82 percent of that presenting volume to the ED into the MIC, which then freed them up to take more critical patients.”

Another by-product of this approach is that clinic encounters are much less expensive than an ED encounter and even less expensive than an urgent care visit. Cost to families is reduced.

All Hands on Deck

Making this clinic a reality in “normal” times would require cooperation from several departments and functions. Given the compressed timeline, it was essential that everyone pull together quickly.

“I can't think of one division that didn't contribute in some way or another,” noted Romano.

These efforts included relocation of some services to accommodate the space needed for the clinic. A few examples at Liberty are:

  • Infusion center space was needed for the clinic.
  • Perioperative Services gave up some of their space for the infusion patients.
  • Sleep studies moved their daytime studies down to Burnet.
Locations: Liberty and Burnet EDs Hours: Liberty (noon to 5 pm) Burnet (5 to 9 pm) Number of patients seen (as an example): Week 1 at Liberty (Burnet location opened Sept. 20) Cared for 30 children
  • 8 on Wednesday
  • 15 on Thursday
  • 7 on Friday

Types of patients

  • Viral URI
  • Ear infections
  • Asymptomatic COVID testing
  • COVID tests, strep tests, and chest X-ray

Average wait time: < 10 minutes Length of stay: 30-90 minutes

How Does It Work?

  1. A patient comes to the main desk in the ED.
  2. A nurse greeter and registrar will assess the patient's chief complaint and do a quick assessment.
  3. They then decide the best place for the patient to receive care – MIC, Urgent Care or ED (depending on time of day and if MIC or Urgent Cares are open).
  4. Parents decide if they want to wait in the Emergency Department or if they want to come to the MIC. If the family chooses to come to the MIC, they take a seat in the waiting room, and we give them an appointment in the system.
  5. Medical assistant walks them back to their room where they are treated in the MIC.
  6. ED patients will follow the normal ED path.

How do we decide which area makes the most sense for patients to receive treatment? Roughly, kids with a cough and a cold or runny nose, fever, headache or sore throat may go to the MIC. Kids who need stitches or have a sprained ankle might go to Urgent Care. Higher acuity issues will stay with the ED.

What has the impact been on staff?

“ED staff shared that it has helped their morale. I think just knowing people were there to support them gave them the energy they needed to keep pushing through. That meant the world to them. And the people who are working the clinic know they are helping,” said Romano. “It's just so wonderful to see everybody coming together so quickly for the kids.”

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