ABSTRACT
BACKGROUND: The COVID-19 pandemic has forced a shift from in-person to virtual care to reduce exposure risks to patients and health care workers. This report aims to describe a large primary care system's implementation of virtual respiratory urgent care clinics (VRUCs). METHODS: The VA Connecticut Healthcare System (VACHS) delivers care to more than 58,000 veterans in at 8 primary care sites. VRUCs were established as part of the VACHS primary care rapid transition to virtual care model. Retrospective analysis and qualitative chart reviews were performed from February 2020 through May 2020 to describe characteristics of patients who received care through the VRUCs. RESULTS: VRUCs were used by > 445 patients, 51% received COVID-19 testing, 10% tested positive, 5% were admitted to the hospital, and 18% had ≥ 1 subsequent emergency department visits. Chart documentation rates of discussion of isolation precautions, high occupational risk, and goals of care were 71%, 25%, and 14%, respectively. CONCLUSIONS: Average wait time for health care provider evaluation was 104 minutes, suggesting VRUCs are an expedient means to provide assessment of COVID-19 symptoms. Use of templated notes may ensure routine counseling about isolation, occupation, and goals of care.
ABSTRACT
INTRODUCTION: Traditionally, health care delivery in the USA has been structured around in-person visits. The COVID-19 pandemic has forced a shift to virtual care models in order to reduce patient exposure to high-risk environments and to preserve valuable health care resources. This report describes one large primary care system's model for rapid transition to virtual care (RTVC). SETTING AND PARTICIPANTS: A RTVC model was implemented at the VA Connecticut Health Care System (VACHS), which delivers care to over 58,000 veterans. PROGRAM DESCRIPTION: The RTVC model included immediate virtual care conversion, telework expansion, implementation of virtual respiratory urgent care clinics, and development of standardized note templates. PROGRAM EVALUATION: Outcomes include the rates of primary encounter types, staff teleworking, and utilization of virtual respiratory urgent care clinics. In under 2 weeks, most encounters were transitioned from in-person to virtual care, enabling telework for over half of the medical staff. The majority of virtual visits were telephone encounters, though rates of video visits increased nearly 18-fold. DISCUSSION: The RTVC model demonstrates expeditious and sustained transition to virtual care during the COVID-19 pandemic. Our experiences help inform institutions still reliant on traditional in-person visits, and future pandemic response.