ABSTRACT
QUALITY ISSUE: The emergence of coronavirus disease of 2019 (COVID-19) highlights the necessity of rapidly identifying and isolating potentially infected individuals. Evaluating this preparedness requires an assessment of the full clinical system, from intake to isolation. INITIAL ASSESSMENT: Unannounced Standardized Patients (USPs) present a nimble, sensitive methodology for assessing this readiness. CHOICE OF SOLUTION: Pilot the USP methodology, which employs an actor trained to present as a standardized, incognito potentially infected patient, to assess clinical readiness for potential COVID-19 patients at an urban, community safety-net clinic. IMPLEMENTATION: The USP was trained to present at each team's front desk with the complaint of feeling unwell (reporting a fever of 101 degrees Fahrenheit in the past 24 hours) and exposure to a roommate recently returned from Beijing. The USP was trained to complete a behaviorally anchored assessment of the care she received from the clinical system. EVALUATION: There was clear variation in care USPs received; some frontline clerical staff followed best practices; others did not. Signage and information on disease spread prevention publicly available was inconsistent. Qualitative comments shared by the USPs and those gathered during group debrief reinforced the experiences of the USPs and hospital leadership. LESSONS LEARNED: USPs revealed significant variation in care practices within a clinical system. Utilization of this assessment methodology can provide just-in-time clinical information about readiness and safety practices, particularly during emerging outbreaks. USPs will prove especially powerful as clinicians and systems return to outpatient visits while remaining vigilant about potentially infected individuals.