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Best practices from the field how one health center battles covid 19
- 1. Best Practices from the Field: How One Health Center Battles COVID-19 Margaret Currie-Coyoy, QI Director Ritchie Glaspy, Population Health/ Quality Manager
- 2. Objectives ➢ Share our experiences, protocols, and key learnings, since the beginning of the COVID-19 pandemic ➢ Illustrate how Safety, Partnership, and Access are the building blocks of our successes ➢ Demonstrate how striving to be a Highly Reliable Organization (HRO) is helping our organization move forward so that we can continue to serve our community
- 3. About Us…
- 4. About Us…
- 6. COVID-19 Timeline at CRCHC First Draft of COVID- 19 Protocol First COVID- 19 Test COVID- 19 Process Audit COVID Task Force Tele- health Rapid Mobile Testing February 2020: Monitoring situation, proceeding with 2020 plans Early March March 12th Mid March Mid March May 7th Early April Continuous Improvement
- 7. A few of the challenges… ➢ Being new to a pandemic ➢ Change fatigue ➢ Ensuring we are meeting needs of elderly patients, patients with chronic diseases, children ➢ Re-thinking care while still providing access ➢ Personnel challenges, going virtual to protect high risk staff ➢ Loss of revenue ➢ Ongoing changes in billing ➢ Ongoing changes in legislation (HR)
- 8. Safety Protocols Audits Education/Exerc ises Access TRIAGELINE TELEPHONICVISITS TELEHEALTHVISITS Partnerships Rapid Testing Testing Totals/Analysis Partnership Process • Protocols • Audits • Education/ Exercises • TRIAGE LINE • TELEPHONIC VISITS • TELEHEALTH VISITS • Rapid Testing • Testing Totals/Analysis • Partnership Process The CRCHC Approach
- 9. And, of course, an amazing team… • CEO • COO • CMO • CFO • DOCS • Grants Manager • Administrative Staff • Billing Staff • HR • QI and Risk • Dental and Medical Providers • Behavioral Health Clinicians • RNs, MAs, Health Coaches • Site Coordinators • Outreach & Enrollment Team • Referral Staff • Interpreters • Facilities Manager • Community Partners & Vendors • Our patients and families
- 10. Safety
- 11. 5 Principles of High Reliability Organizations
- 12. “What could go wrong?” The reality: Asymptomatic and symptomatic COVID- 19 patients will seek care at our clinics. The response: ➢ How can we identify individuals with exposure? ➢ How can we keep patients and staff safe? What ifs: ➢ What if someone comes in undetected? ➢ What if we don’t have sufficient PPE?
- 14. “What ideas do you have?” “What ideas do you have?” ➢ Mask wearing for all staff, patients, visitors ➢ Review of upcoming appointments to reschedule visits if medically indicated
- 15. Understanding our PPE levels
- 16. Additional Safety Measures ➢ Daily temperature checks ➢ Tele work for non- essential staff ➢ Safe passage letters for essential staff ➢ Elimination of all in- person meetings
- 17. “What’s working? What’s not? Let’s Improve!”
- 20. Access
- 21. 69 77 145 317 278 269 251 234 279 227 203 161 187 311 397 0 50 100 150 200 250 300 350 400 450 Mar 2-6 Mar 9-13 Mar 16-19Mar 23-27 Mar 30- Apr 3 Apr 6-10 Apr 13-17 Apr 20-24 Apr 27- May 1 May 4-8 May 11- 15 May 18- 22 May 25- 29 June 1-5 June 8-12 Count COVID-19 Triage Call Volume
- 22. Rethinking Access: Telehealth & Telephonic
- 23. The Process
- 25. The Data
- 26. 52 150 387 121 1 1 7 Phone Consultation: Location China Grove Logan McGill NRFM Patterson Farms Salisbury HC Homeless Clinic China Grove 14% Logan 19% McGill 23% NRFM 43% Homeless Clinic 1% BHC Phone Consultation: Location China Grove Logan McGill NRFM Homeless Clinic 112 44 46 21 0 20 40 60 80 100 120 Provider 1 Provider 2 Provider 3 Provider 4 BHC Phone Consultation: Provider 40 3 123 41 89 54 61 64 62 1 8 111 55 7 0 20 40 60 80 100 120 140 Count Provider Medical Phone Consultation: Provider
- 27. 1 10 11 57 13 Medical Telehealth: Location CRCHC HOMELESS CLINIC CHINA GROVE LOGAN MCGILL MEDICAL NRFM 40 92 45 65 2 BHC Telehealth: Location China Grove Logan McGill NRFM Homeless Clinic 77 27 128 12 0 20 40 60 80 100 120 140 Provider 1 Provider 2 Provider 3 Provider 4 BHC Telehealth: Provider 6 2 11 5 13 1 4 8 3 1 26 9 3 0 5 10 15 20 25 30 Provider 1 Provider 2 Provider 3 Provider 4 Provider 5 Provider 6 Provider 7 Provider 8 Provider 9 Provider 10 Provider 11 Provider 12 Provider 13 Medical Telehealth: Provider
- 28. 410 457 416 566 346 296 270 348 384 385 406 256 231 426 519 0 100 200 300 400 500 600 Count COVID-19 Spanish Appt. Call Volume 898 982 1115 965 894 804 705 862 807 931 827 517 583 10881072 0 200 400 600 800 1000 1200 Count COVID-19 English Appt. Call Volume
- 29. The Response
- 31. 518 453 471 404 13 6 34 43 0 100 200 300 400 500 600 Scheduled Kept In-Person In-Person Kept Telehealth TH Kept Phone Phone Kept MEDICAL Appointment Detail 64 48 8 0 31 28 17 20 0 10 20 30 40 50 60 70 Scheduled Kept In-Person In-Person Kept Telehealth TH Kept Phone Phone Kept BEHAVIORAL HEALTH Appointment Detail 34 22 34 22 0 0 5 10 15 20 25 30 35 40 Total Scheduled Total Kept In-Person In-Person Kept Telehealth DENTAL Appointment Detail COVID-19 Appointment Detail Analysis
- 32. COVID-19 Operational Adjustments & Monthly Goals • Face 2 Face Encounters: • 1,500 per month/75 per day • Schedule at the least 110 appointments per day to account 30% No Show/Rescheduled Rate • Virtual Encounters • 500 per month/25 per day • Schedule at least 35 virtual appointments per day • $20,000 in past A/R • 1,943 Monthly Encounters • $40,000 Monthly Collection • $2,000 Per Day • Scheduling • Schedule 6-8 daily • Keep 6 or more dental appointments daily • Increase provider’s in-person appointments starting 6/15 • Schedule CPEs on Tuesdays, Wednesdays, and Fridays • Increase provider’s telehealth and telephonic appointment volume • Decrease Salisbury clinic operations to 1 day a week (Thursday)
- 33. 81% 7% 11% 80% 5% 15% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Face to Face Telehealth Phone Appointment Forecast: Actuals vs. Goals Actual Goal
- 34. Telehealth No Show Analysis
- 35. Telehealth No Show Analysis
- 37. “What did we learn?” ➢ Weekly COVID Task Force ➢ Data driven approach
- 38. 13 16 13 6 15 10 2 8 6 16 8 6 2 3 3 10 5 0 4 6 5 1 1 1 4 3 3 1 2 1 0 2 1 1 0 2 1 2 0 1 4 1 0 0 0 2 3 1 2 11 13 8 7 11 10 4 7 8 1 13 11 4 1 3 6 3 4 7 0 2 1 1 1 0 5 1 0 0 0 2 1 0 1 0 2 1 0 3 0 0 0 0 0 1 1 5 1 1 0 2 4 6 8 10 12 14 16 18 3/23/2020 3/25/2020 3/27/2020 3/29/2020 3/31/2020 4/2/2020 4/4/2020 4/6/2020 4/8/2020 4/10/2020 4/12/2020 4/14/2020 4/16/2020 4/18/2020 4/20/2020 4/22/2020 4/24/2020 4/26/2020 4/28/2020 4/30/2020 5/2/2020 5/4/2020 5/6/2020 5/8/2020 5/10/2020 5/12/2020 5/14/2020 5/16/2020 5/18/2020 5/20/2020 5/22/2020 5/24/2020 5/26/2020 5/28/2020 COVID-19 Rescheduled Appt. Timeline (March 23 to May 29) COVID R/S COVID Cancel
- 40. 5 Principles of High Reliability Organizations ACCESS: TELEHEALTH & TELEPHONIC Preoccupation with Failure • Rapid Change Management • Troubleshoot Glossary • Patient & Staff Feedback Sensitivity to Operations • Not reinventing the wheel • Frontline Workers Reluctance to Simplify • Billing • Operations • Workflows Commitment to Resilience • Preliminary Success Outcomes • Root Cause Analysis Deference to Expertise • BHC Scheduling Coordinator • Billing • FD Operations
- 41. Partnerships
- 42. Rapid COVID-19 Site Testing
- 43. The Process
- 44. Rapid Testing Roles and Responsibilities
- 45. Rapid Testing Roles and Responsibilities (cont.)
- 51. Testing Sites
- 52. The Data
- 53. Rapid Testing Market Analysis
- 56. The Response
- 57. In the community… ➢ Rowan Helping Ministries ➢ Cabarrus Salvation Army ➢ Concord Housing Department ➢ Rowan Health Department
- 58. “Let’s ask an expert.”
- 59. Tests Conducted - thru 6/19/20 Site Where Tested Antigen (LabCorp) Antigen (Rapid) Antibody (IGG / IGM) Grand Total Total Unique Patients CRCHC MOBILE UNIT 56 367 0 423 341 MEDICAL CHINA GROVE 28 0 1 29 29 MEDICAL LOGAN 33 0 2 35 33 MEDICAL MCGILL 145 36 12 193 149 MEDICAL NRFM 167 171 22 360 295 Grand Total 429 574 37 1040 847 Positives - thru 6/19/20 Site Where Tested Antigen (LabCorp) Antigen (Rapid) Antibody (IGG / IGM) Grand Total Total Unique Positives CRCHC MOBILE UNIT 0 58 0 58 52 MEDICAL CHINA GROVE 6 0 0 6 6 MEDICAL LOGAN 7 0 0 7 4 MEDICAL MCGILL 31 0 1 32 25 MEDICAL NRFM 28 38 5 71 65 EXTERNAL 21 0 1 22 22 Grand Total 93 96 7 196 174 CRCHC COVID-19 Testing Data
- 60. 5 Principles of High Reliability Organizations PARTNERSHIP: RAPID MOBILE TESTING Preoccupation with Failure • What if patients “walk-up?” • What if we are overwhelmed with demand? Sensitivity to Operations • Changed from paper registration to iPads Reluctance to Simplify • Pre-site visits • Redesigned traffic flows Commitment to Resilience • Huddles • Amazing teamwork Deference to Expertise • Frontline staff • Facilities Manager • NC Public Health • Community Partners
- 61. Please also e-mail us: QUESTIONS? Ritchie Glaspy: RGlaspy@crchc.org Margaret Currie-Coyoy: mcurriecoyoy@crchc.org
- 62. References • http://www.crmpo.org/ • http://app.ihi.org/FacultyDocuments/Events/Event-2491/Presentation- 10595/Document-8970/Tools_HRO_Principles.pdf • https://www.qualitydigest.com/inside/management-column/getting-real- rapid-cycle-pdsa-021616.html • Weick, Karl E.; Sutcliffe, Kathleen M. (2007). Managing the Unexpected. Hoboken, NJ: Jossey-Bass.