Hospitals Create Temporary Clinics To Relieve Crowded Emergency Departments

Aviva mobile vaccine Roseburg.jpeg

In Central Oregon, St. Charles Health System’s Bend hospital has set up a new temporary urgent care clinic on its campus, within 150 yards of the emergency department. 

Faced with a flood of patients, the health system moved quickly to establish the clinic in an existing building in the hospital. Staff and equipment arrived the last weekend of August. It’s now a critical piece of the hospital’s response to the surge of patients as COVID-19 slams Oregon. 

“The whole point of that was to try to take some of the pressure off our emergency department,” said Mike Richards, vice president of operations for St. Charles Medical Group, the health system’s network clinics. 

The clinic was set up over the weekend before Labor Day. Patients are directed to the temporary clinic if they can be treated there instead of the emergency department, Richards said.

Patients aren’t turned away from the emergency department if they have critical needs, like a potential heart attack or stroke.

St. Charles’ move is just one example of how hospital emergency departments have adapted as they face a crush of patients seeking care for COVID-19 and other serious illnesses or injuries.

Around the country, hospitals are trying different approaches.

Many have set up temporary tents to direct patients to the right type of care. Others, like St. Charles, have existing building space nearby. But the overall mission is the same: to treat all patients and keep pressure off emergency departments so they can focus on the most serious needs. 

For example, PeaceHealth Southwest Medical Center in Vancouver last month set up a tent as a waiting area outside the emergency department. 

In addition to setting up temporary facilities near emergency departments, hospitals are also asking people to seek treatment for minor ailments at an urgent care instead of an emergency department.

Hospitals are desperate to keep beds and emergency department capacity clear to handle serious cases.

On Friday, Oregon hospitals had 49 adult intensive care beds open, just 7% of the 683 total. Hospitals had 309 available adult beds outside of intensive care units open, also 7% of the state’s 4,289 adult non-ICU beds. 

Across Oregon, 1,172 patients were hospitalized with COVID-19 on Friday. 

Drive-Through Testing

St. Charles administrators aren’t sure how long they will keep the temporary urgent care clinic open.

“At the moment, we're planning through the end of November,” Richards said. “It all depends on what our volume's doing. We will definitely not take it down until it's clear it's no longer needed.”

Urgent care clinics can treat people for a variety of conditions, including respiratory illnesses, cuts and fractured bones. 

The nonprofit St. Charles Health System has existing, permanent urgent care clinics elsewhere in central Oregon, including in Bend, La Pine, and Prineville. 

The health system is also doing a lot of COVID-19 drive-through testing in Bend and Prineville, where residents pull in and get swabbed. That eases pressure on emergency departments, Richards said, because patients were coming into the emergency department to get tested when they had mild symptoms. 

In Bend, 200 to 300 patients a day go through drive-through testing.

The pandemic has pushed hospitals to innovate.

“If you had asked us to (set up a temporary clinic) 18 months ago, I think people would have freaked out with hair on fire, but we have learned so much and adapted,” Richards said. 

Typical permanent urgent care clinics are open for 12 hours from 8 a.m. to 8 p.m. But staffing the temporary clinic for 12 hours would have been difficult, as St. Charles, like other systems, is short on staff. So, the new temporary site is open 8 a.m. to 4 p.m. That helps the emergency department during the heavy morning rush of patients.

When the clinic opened, it drew about six to a dozen patients a day. Now it sees about 20 patients on average each day, including about three or four patients triaged from the emergency department to the urgent care clinic.

St. Charles’ permanent urgent care clinics are seeing increased demand too. 

The urgent care on the south side of Bend has treated 120 to 130 patients on some days during the surge. That’s double its average volume of 60 to 70 patients before the surge.

Southern Oregon Efforts 

In Roseburg, a tent outside CHI Mercy Health’s Mercy Medical Center is a visual reminder of the strained system.

The tent is a pre-emergency-room triage site for patients seeking emergency care at the hospital. It’s a partnership between the hospital, Medicaid insurer Umpqua Health Alliance and Aviva Health, a nonprofit federally qualified health center with 10 clinics throughout Douglas County. Federally qualified health centers offer primary, dental and mental health care to low-income people. 

The site is set up to identify COVID-19 positive patients who don’t need emergency care but need medical care.

Patients are screened under a tent near the emergency room entrance. Those who are COVID-19 positive but don’t need emergency room care go to “Mobile 1,” one of two mobile medical units assigned to Aviva Health by Douglas County. 

Patients get an exam and advice on treatment options. If they need more medical care, they can go to a separate location to get limited services, such as monoclonal antibody therapy, oxygen, and intravenous fluids. 

The triage system helps divert patients to care who would otherwise sit in the emergency room for hours, said KC Bolton, CEO of Aviva.

About 20% of the people who would normally be handled in the emergency room are now managed through the mobile clinic, Bolton said, stressing the effort is a partnership among the groups and follows the hospital’s clinical protocols. Umpqua Health Alliance handles the case management for patients.

“The partnership of UHA and Aviva Health in setting up this triage tent during our COVID surge is a welcome assistance to allow patients seeking non-emergent care to receive treatment,” said Dr. Jason Gray, chief medical officer of CHI Mercy Health.

Among the benefits, the process cuts down on unnecessary exposure to COVID-19 in the hospital’s emergency department.

Tent staff wear N-95 respirator masks and protective gowns and gloves.

The triage system doesn’t replace the fast-track work inside the hospital’s emergency room for rapidly moving health crises and orthopedic injuries. 

Staff communicate by radio to determine where patients will go.

“It’s a little bit of a battlefield medicine approach,” Bolton said in an interview with The Lund Report.

Aviva Health also has set up an acute care clinic in Roseburg for patients with symptoms of COVID-19, flu and colds. The clinic is in a space that previously served as the vaccination clinic.

At the same location, the health center has changed its COVID-19 testing and vaccination services to a drive-through model. That clinic helps keep people with COVID-19 away from other patients.

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.

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