Student Health Professional Patient Triage Initiative
In response to the spread of the COVID-19 pandemic in the city of Philadelphia, outpatient medical practices at Thomas Jefferson University Hospital (TJUH) faced a sudden need to adapt their workflow to protect their patients and staff, as well as abide by requirements for social distancing to prevent the spread of infection. After the state shutdown of services, physicians quickly identified the need to reevaluate in-person patient care and determine if their patient’s needs could be addressed virtually. It quickly became evident that patients could be triaged, screened, educated, and offered to have their visits converted to telehealth over the phone, while allowing those with active medical issues priority over in-person clinic visits. However, these extra patient phone calls proved to significantly increase the burden on clinic staff, especially due to the increased demand on their office in the face of the pandemic. It became clear that a solution to alleviate this burden was necessary. In order to address these concerns, medical students at Sidney Kimmel Medical College (SKMC) worked in collaboration with the outpatient faculty to create a student volunteer program in order to adapt the workflow to virtually involve health professional students from multiple colleges at Thomas Jefferson University (TJU).
This project primarily focuses on the response of the Jefferson Internal Medicine Associates (JIMA) and the Jefferson Women’s Primary and Specialty Care (WPSC) response to the COVID-19 pandemic. The faculty at JIMA and SKMC students worked together to set up a volunteer system whereby students would call patients, thus allowing the office to accomplish other immediate patient care needs. Students signed up through an online portal that served as a centralized forum for all student volunteer projects related to COVID-19 at TJU. Novel telephone scripts and instructions for participation in the JIMA volunteer initiative were written and distributed to student volunteers. Additionally, a standardized documentation system was created in order to streamline the workflow. A student project coordinator was selected to lead efforts organizing the volunteer initiative between the office, the students, and the patients. Student volunteers were assigned a cohort of patients to call, and Doximity Dialer was used to contact patients for privacy and confidentiality. Students would return their documentation materials to the student project coordinator when they finished contacting their cohort of patients. The student project coordinator communicated closely with the faculty at JIMA and compiled all materials collected from student volunteers for return to department staff. Please see our downloadable materials for the script, workflow, and instructions used in this project. During the initial three months of the project, our goal for JIMA was focused on pre-triaging patients prior to their clinic appointments. This consisted of tasks such as converting patients’ appointments to either telemedicine visits or telephone visits, rescheduling or canceling appointments, and keeping in person appointments if it was medically necessary. Once the office established an internal workflow and patients began coming in more frequently for in-person visits, we re-developed our approach to patient care. We moved to having students primarily screen patients for COVID-19 via telephone prior to their office visits, in addition to continuing to assist patients with changing their appointments.
The JIMA project was then implemented at the WPSC office utilizing the same workflow and documents. The project transitioned to utilizing multiple student project coordinators due to the expansion of the program. This workflow was also adapted and expanded to other offices in the Thomas Jefferson University System. For the JIMA program, we had about 200 student health professional volunteers from the Sidney Kimmel Medical College, College of Nursing, College of Health Professionals, and Physician Assistant Studies. In the initial three months of the program, between March 19th and May 15th, we called 2,734 patients to discuss their upcoming appointments with a large portion canceling, rescheduling, or unable to be reached. When the program was shifted to a screening focus, from May 15th until July 23rd, a total of 2,213 calls were placed. Of these, 1,579 patients were reached: 1,011 confirmed their in-person appointments with negative COVID-19 screens, 227 were telehealth or converted to telehealth, 110 rescheduled, 109 cancelled, and 122 patients had positive COVID-19 screens and were referred for further assessment by the attending physician. For the WPSC program, between June 1st and July 22nd, about 128 student health professional volunteers from similar colleges as the JIMA program, made a total 1,777 patient outreach calls in an attempt to confirm patients’ appointments and screen them for COVID-19 the day prior to their scheduled appointment. 1,372 patients were reached: 781 confirmed their in person appointment, 591 confirmed a telehealth or telephone appointment, 85 scheduled or canceled, and 51 were referred to the office nurse due to a positive COVID-19 screen. Within both programs, there was a robust volunteer response from student health professionals from multiple colleges. The Doximity Dialer app worked well to contact patients, but a large majority were still not able to be contacted. Many patients preferred to cancel or reschedule their in-person appointments at the start of the pandemic rather than convert them to telehealth or telephone visits. When screening for COVID-19, most patients screened negative with few needing to be referred to a nurse or physician. This program created an optimal workflow for student health professionals to assist with ambulatory offices to contact patients quickly, effectively, and keep the patients and office staff safe. In the future, areas that should be explored include finding ways to reach more patients and streamlining the conversion of their visits to telehealth or telephone appointments.