1 of 17

There and Back Again: Reopening SRFCs during COVID

SRFCFA annual meeting

March 11, 2021

WIlliam Hay, MD, Brain Sick MD, Rebecca Lundh MD,

Terese E Lewis P3, Quynh T Tran P3,

Allison Miller, PD3, Spenser Marting, M2

2 of 17

UNMC SHARING CLINIC

5 of 17

The GOODLIFE MODEL

1. Pre-clinic huddle/identify self-role & patient care teams

2. Two to three disciplines co-interview together

3. Stay in IP teams though the entire evening

4. Each discipline writes their own notes

6 of 17

The GOODLIFE MODEL (continued)

5. Shared responsibilities & coverage

6. Explore & expand roles for each discipline

7. Use EHR to see that patients seen by all disciplines over time

8. Interprofessional precepting

7 of 17

SHARING before Covid

1. Arrival and check by pain Medical Assistant

2. Vital by Student nurse

8 of 17

SHARING during COVID19

Sun. 8 Mar. 2020

Dr Hay returns from conference on Student Run Free Clinics

Monday

UNMC cancels all travel
Discussion with Deans office status of Clinic

Tuesday

Students prohibited from direct patient contact

All SHARING clinics canceled

9 of 17

Reopening – Patient difficulties�How to treat patients without direct contact?�

Needed to create list of SHARING patients

Patients may have limited technology

Few have computers

Cell phones vs landlines

Cost of streaming data

How to get medications

to patients

10 of 17

Reopening- �student/faculty difficulties

Physicians inexperienced with telehealth
How do we maintain interprofessional aspect of clinic
Can’t have groups of students & faculty together due to COVID risk

11 of 17

Reopening – the solution

Zoom

Allows isolation and so COVID safe
Used for student and faculty communication
Breakout rooms used to discuss individual patients
Faculty can move between break out rooms
Allows shared view of our electronic health records

Patient contact

Felt best to use phones as all patients had one

12 of 17

COVID Telehealth Clinic

Started back with fewer student disciplines:

Medical
Physician Assistant
Pharmacy
Social work

Later reintroduced:

Nutrition
Physical therapy

13 of 17

COVID Telehealth Clinic:�New format

Patient questioned about telehealth capabilities
Student team interview:

Social work - food, housing, etc
PCP student - MD or PA
Pharmacy student

Presentation to faculty - MD, Pharmacy & if needed Social Work
Review of plan with patient and orders
Pharmacy mailed prescriptions; all copayments eliminated (need credit card)
Patient’s scheduled for inperson visit with faculty when needed

14 of 17

COVID Telehealth Clinic Outcomes

Students proficient at hosting Zoom meetings
Patients very satisfied with format
Easier to get faculty volunteers as can work from home
Very few patient required inperson visits
Appointment no show rate improved from 40-50% to <10%

Difficult to get patients to come in for labs
Some health maintenance activities delayed

15 of 17

Future of SHARING

Challenges with reopening (planned January)

Inconsistent COVID precausion policies between disiplines
Coordination with managers of facilities on safety measures
PPE availablility
Limit of 3 people per patient room

Solutions: Utilize telehealth technology

Precepting via zoom, inperson only when needed
Include other disciplines in patient room with Zoom
See ½ of patients inperson, the rest via teleheath