In the novel coronavirus disease 2019 (COVID-19) pandemic, social distancing has been necessary to help prevent disease transmission. As a result, healthcare providers have had to limit access to in-person patient visits. This poses a challenge to maintain appropriate patient care without putting patients at greater risk by being in a hospital setting, while also trying to reduce a back log of waiting lists as restrictions are lifted. Many important healthcare services have uniquely adapted to the COVID-19 pandemic. For example, at The Royal Surrey County Hospital NHS Foundation Trust, a drive-through pharmacy has been initiated, enabling patients to safely collect pre-prescribed medications. This inspired our team of Cardiac Physiologist’s to use this model to provide a cardiac device follow up service, where remote or online appointments were not possible. The high-risk and vulnerable nature of cardiac patients meant developing a service that could be delivered while maintaining the highest level of infection control and social distancing measures.
The concept of the drive-through clinic is straightforward, safe and reproducible. Risk assessments were carried out to ensure the process would be effective and low-risk and standard operating procedures were drawn up. The unit is staffed by two cardiac physiologists in personal protective equipment (a disposable apron, surgical facemask and gloves) for every clinic. One carries out the device check and one completes the appropriate paperwork and reports. Patients remain in their own car throughout the appointment, removing time being spent within the hospital. This minimises the risk of COVID-19 transmission between staff and patients without compromising care, alleviating patient anxiety.
Upon arrival, the car approaches the mobile unit. The physiologist signals the patient to drive up to the window and asks the patient to turn their engines off when in a suitable position. A programming wand (contained in a disposable single use sterile transparent polythene sleeve) is handed to the patient through the car window. A complete device check is performed and any necessary information such as medication changes or symptoms are recorded. Any programmable treatment/changes can be carried out and for new or recent implants, visual wound site checks can be carried out through the car windows. If any further evaluation or hospital admission is required, physician support is available via telephone or instant messaging. The unit has also been placed in an area where the physiologist’s have quick and easy access to a crash trolley and resus equipment, should it be needed in an emergency situation.
Following the success of the drive-through device clinic, the unit is now utilised for a cardiac ambulatory monitoring service also. Holter monitors are pre-programmed and packaged in individual envelopes with simple and clear instructions of how to correctly fit the monitor. As in the device clinic, patients arrive in their cars and drive up to the window. A physiologist hands the patient the envelope and explains how to fit the monitor and how to complete the symptom diary. The patient then leaves, fits the monitor in their own home and returns it in the same way the following day. Any questions or concerns that patients may have can be answered either at collection or drop-off of the equipment.
The drive-through clinics has been extremely well received by patients. Patient experience surveys have allowed us to obtain feedback and also compare traditional methods to this innovative way of continuing patient care. Overall satisfaction of the service has been high and appointment compliance has been excellent. In response to the pandemic the pioneering drive-through clinic has been shown to be practical and effective and could be utilised at many healthcare settings across the country. It has enabled the cardiology team to continue doing their job, without compromising patient or staff safety.
Author: Aisling O’Regan MSc, BSc
Royal Surrey County Hospital NHS Foundation Trust