In March 2020, Naval Medical Center Portsmouth (NMCP) implemented a Car Triage screening process in wake of the Novel Coronavirus Disease 2019, or COVID-19.
The development is designed to triage, test, and treat low acuity patients with a suspicion of COVID-19, and to protect medical staff by doing so in an open air environment.
“This is all designed to keep patients in their vehicle, preventing spread of potential infections in waiting rooms and treatment areas of the hospital,” said Cmdr. Peter Cole, NMCP’s Emergency Medicine department chair. “Most patients are in and out in less than 45 minutes.”
During the process, vehicles that pull up to the main gate are directed to the right lane if they are intending to go to the Emergency Department (ED), or if they have any potential COVID-19 concerns. After the main gate, the vehicles head to the Building 3 lot where there are tents set up. An initial screener will ask a few simple questions while the patients remain in vehicles; the patients are directed to the ED or to the Car Triage, as appropriate.
“Nurses, dentists, and corps staff have a list of criteria by which a patient is deemed safe for evaluation in their vehicle,” Cole said. “If need be, they may be directed either to the ED for further care or to the second tent, where they will remain in their vehicle and get evaluated by a licensed provider. There are evaluation areas available if the provider needs to have the patient get out of the car, but this usually is not necessary. There is also portable X-ray capability in case a chest X-ray is required. After the evaluation, the provider may prescribe medicines – these are all on-hand, eliminating the need for patients to wait in the pharmacy.”
The success of the Car Triage has been due to the efforts of the entire command, including medical center leadership, emergency management, and all the personnel who have been sent from other areas of the medical center to assist in this endeavor.
“One of the greatest concerns in a global pandemic is the overwhelming of hospital resources due to the sheer volume of patients who are seeking care,” Cole said.
Implementing the Car Triage process has had a great impact on the Emergency Department and NMCP as a whole.
“It has been a tremendous help to keep the ED flowing smoothly,” Cole said. “Since it started, the average length of stay in the ED dropped almost 30 minutes per patient. This may not seem like a lot, but when you realize we see almost 6,000 patients a month, it certainly adds up.”
The percentage of patients who left without being seen by a provider has dropped to zero in the last two weeks.
Cole said that NMCP’s admission rate rose 170 percent. This shows that the patients that are making it to the ED are the ones who truly need to be there.
Along with the Car Triage, NMCP’s COVID-19 Call Center and screening advice line has helped to reduce the amount of foot-traffic through the ED.
“Patients can call in and get better directions on what they should do if they believe they have symptoms,” said Hospital Corpsman 2nd Class Michael Doxtator, Car Triage team lead. “Between the call center and the triage, we are really helping make a difference during this situation.”
Since it began, NMCP’s Car Triage has undergone several changes to improve the process as more information becomes available.
“This has been a group effort from the start, requiring heavy lifting from almost every directorate and a number of departments,” Cole said. “This would not be possible without the assistance of dozens of people from all over, contributing to the effort. Everyone can be very proud of this, it is something about which the entire command can hold their head high.”
As the U.S. Navy's oldest, continuously-operating military hospital since 1830, Naval Medical Center Portsmouth proudly serves past and present military members and their families. The nationally-acclaimed, state-of-the-art medical center, along with the area's 10 branch health and TRICARE Prime Clinics, provide care for the Hampton Roads area. The medical center also supports premier research and teaching programs designed to prepare new doctors, nurses and hospital corpsman for future roles in healing and wellness.
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