Family Medicine Leaders During COVID

Describe what you/your faculty/department/program/clinic did that demonstrated that family physicians are leaders in health systems.
We created a Respiratory Evaluation Center (REC) and a program for primary care support of the emergency department (ED). In partnership with our general internal medicine colleagues and utilizing what was formerly the family medicine on-campus clinic location, within the space of five days of the initial request from senior health system leadership, we created, staffed, and opened the REC in order to see non-emergent patients with respiratory illness. Centralizing patient evaluations at the REC helped unload volume from the ED, and preserved PPE and COVID testing supplies by directing patients to one location for this care instead of having multiple locations drawing from limited stock.

At the same time, we moved our clinical operation into shared space with general internal medicine and in that location we created Primary Care ED Support in which family medicine physicians would see select non-urgent patients upon direct referral from the triage clinician in the ED. As ED volumes stabilized, the Primary Care ED Support was no longer needed; however, the REC operations have continued to this date, though the target patient populations have changed over time.

Whereas in the REC we were initially seeing patients from the ED and also from other services such as transplant and obstetrics, we currently are seeing primarily our employees, our own primary care patients, and other ambulatory patients with COVID symptoms as well as some of our health sciences campus students. From March 18, 2020 through the end of December, 2020, the family medicine and internal medicine clinicians in REC saw more than 5,000 patient visits.

How did you communicate with health systems leaders during the process?
Our communication plan involved multiple regular telephone and email contacts. The health system initially had a daily conference call which included our REC leadership team and all those who were key in managing our response. The frequency of these calls decreased over the summer. We also initially provided daily information to senior leaders from REC regarding how many patients were seen, how many tests were ordered, and what our positivity rate was via email. That data collection and reporting to senior leaders has continued, though moving to a weekly rather than daily reporting cadence.

What type of feedback have you received about your efforts?
We received universally positive feedback from patients seen in the clinic and also from the senior leaders. Senior leaders commented repeatedly on our timely, efficient and effective service and our ability to adapt effectively on very short notice to the rapid changes needed in our system’s pandemic response. Other health system clinicians appreciated the REC’s role in ensuring timely patient evaluation while also limiting COVID exposure risks to other patients and staff members in other clinics.

What type of impact do you think this will have on your health systems leaders’ perception of family medicine?
Family medicine’s involvement in this effort clearly highlighted the versatility of our specialty and was widely appreciated by senior health system leadership. In addition, once the REC was running smoothly and we requested to return our faculty and staff to ongoing management of our patient panels, there was strong support for this pivot and a greater understanding of our value to the health system as a whole. Throughout the COVID pandemic response, primary care services and clinicians have demonstrated their flexibility and innovative approaches to problem-solving, and have consistently met or exceeded the health system’s goals.

What type of advice would you give to other family physicians or family medicine faculty about helping health systems leaders see the value of family medicine?
Increasingly, health systems around the country are becoming acutely aware of the value and importance of having a strong primary care presence to ensure competitiveness in value-based healthcare. Being nimble, adaptive and responsive further accentuates this value proposition and our exemplary performance in this example had a very positive impact on senior healthcare leadership in our setting. Family medicine physicians and departments have a commitment to our patients’ and our communities’ wellness and health, and can work within these larger systems to ensure to meet these needs.