Promoting and Maintaining Access: Primary Care in a Pandemic

Kim Regis, DNP, RN, NEA-BC, PNP-BC, BCC, Vice President of Operations, Chief Nurse Executive, Ambulatory

In November 2020, the Primary Care Network at Nationwide Children's Hospital was again recognized as a Patient-Centered Medical Home (PCMH). The network achieved the highest level of standards, Level 3, from the National Committee for Quality Assurance (NCQA), in recognition of the evidence-based, patient-centered and interdisciplinary team care they provide. This recognition came in the midst of a year marked by unforeseen challenges in care delivery during the COVID-19 pandemic. Despite those challenges, the Primary Care Network was able to promote and maintain access to care for patients in the community through operational changes, outreach, communication and commitment.

OPERATIONAL CHANGES To ensure the safety of staff, patients and families, several steps were taken at the onset of the pandemic to limit exposure and transmission of COVID-19. The first major step implemented was to separate sick and well sessions into morning and afternoon so that patients with any acute illness would not be in waiting rooms with well patients. In addition to these measures, the operations coordinators and clinic leadership worked together with our property management partners to customize “banker’s glass” type barriers to fit our leased properties for patient access representatives to have barrier protection when registering patients. All other practices including masks and physical distancing were implemented.

Primary Care’s rapid implementation of best practices enabled them to be an early adopter of allowing COVID-19 positive patients and families into the clinic setting so that medically necessary care would not be delayed. This was especially true for newborns recently discharged from the birth hospital. In April 2020, Epidemiology requested a plan for mothers that tested positive for COVID-19 to bring their newborns to their first well-child visit. The Primary Care Network Newborn Services coordinated a process that merged with the newborn nurseries’ existing discharge pathway to ensure reduced transmission risk and optimized access to care. This innovative approach was integral to maintain access for this vulnerable population. OUTREACH At the end of 2019, Nationwide Children's Primary Care Network was seeing great success in reaching the community through expanding services and increasing access to care. The improvements in access and improved patient outcomes continued into early 2020 prior to the onset of the changes to operations that came about with COVID-19. Increased access equals more vaccines, decreased acute illnesses and decreased infant mortality.

When COVID-19 made its way to our community, the impact on primary care services became immediately apparent as visit volume began to decline. Families heard the message that staying home was the safest thing for them to do. National reports indicated that childhood vaccination rates declined significantly following stay at home orders consistent with the trend. In response to the decline Primary Care launched a massive outreach strategy.

The staff in Primary Care completed more than 25,000 live phone calls. Marketing worked with the teams to create messaging for patients and families to update them on the safety precautions and operational changes implemented to keep them safe. Leveraging technology through text messaging, enrollment of families for MyChart and engaging active users also enabled Primary Care to increase outreach capacity and promote return to care for patients.

COMMUNICATION Keeping the lines of communication open is critical during stressful times. The Primary Care teams stayed connected at all levels with weekly calls for the whole network. The entire leadership team participated in the calls providing pertinent updates and information regarding new workflows, policy changes and successes. A best practice that came from these meetings involved leaving the chat open at the end of the call so that people could type their questions. After the meeting a FAQ was compiled with the questions and answers and sent out to the team.

COMMITMENT

"The best way to find yourself is to lose yourself in the service of others."

— Mahatma Ghandi

Primary Care in a pandemic is uncertain. The staff, the patients and the families are tired and looking for answers. The operational changes, outreach and communication strategies provided some of the answers. As a network and a hospital we have done a great deal to slow the spread, promote and maintain access to care. The work that we have done could not have been done without commitment from the staff. When the staff do not know what to do, we continue to serve. Nationwide Children's Primary Care Network is where everything matters for our families.