Establishing Mayo Clinic's Coronavirus Disease 2019 Virtual Clinic: A Preliminary Communication

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is taking a massive toll on health care systems globally. We developed the COVID-19 virtual clinic (CVC) in conjunction with drive through testing to cope with this situation. There are two arms of the CVC: (1) a screening arm and (2) positive patient arm. Screening is performed over the phone based on the Centers for Disease Control and Prevention screening guideline. Positive patients are followed at regular intervals by video appointments where concerns can be addressed by a provider while also tracking symptom progression. We enrolled 63 positive patients out of 1,153 screened for COVID-19 as of this writing. The CVC continues to address patients' concerns and symptoms in an effort to minimize emergency department and hospital patient volumes, as incidence increases. Drive through testing in conjunction with a virtual clinic allows us to provide high-quality care in an anxious time without consuming excessive personal protective equipment or unnecessarily exposing health care workers. This article could serve as a model to guide other practices to cope with this and future pandemics.

Symptoms and Clinical Outcomes of Coronavirus Disease 2019 in the Outpatient Setting

“…The exact mechanism of interaction between SARS-CoV-2 and the GI tract is not known, but a fecal-oral route has been suggested on the basis of the presence of GI symptoms and positive PCR results obtained from rectal swabs [11,12]. Among severe cases described in the literature, fever generally occurred in more than 90% of patients; however, in our cohort with mild cases, fever was reported only as an early symptom in slightly more than half of patients (56.6%), and overall, one-third of our patients never had a fever during the entire course of their illness [5,13]. This finding highlights the necessity of both temperature and symptom screening for monitoring and for public health prevention efforts.…”

“…We examined the prevalence of select risk factors established by the CDC and a profile of 30 different patientreported symptoms at 4 time points after the call to notify patients of the positive test result: initial symptoms, at the time of contact (call), first follow-up (after 24-48 hours), and second follow-up (24-96 hours after first follow-up) [4]. During each subsequent visit, ongoing symptoms were reviewed and recorded with appropriate downstream management, as described by Jethwa et al [5]. Early on, we followed the CDC's recommendations (at that time) for a test-based strategy for release from self-isolation.…”

Outcomes of Coronavirus Disease 2019 Drive-Through Screening at an Academic Military Medical Center

“…Although our screening method involved face-to-face interviews of patients in their vehicles, other drive-through programs have implemented a web-based questionnaire [ 15 ], telephone triage [ 3–7 , 9 , 14 ], or onsite microphones [ 11 ] for patient assessment or communication. Although we had no cases of COVID-19 in healthcare workers with direct patient interaction, these adaptations would allow for further decreased potential cross-exposure of healthcare workers and patients as well as decreased PPE use [ 6 , 8–11 , 13 ].…”

“…Positioning the drive-through in close proximity to the ED [ 2 , 4 , 5 ] and having provider oversight may have mitigated risk for our program. Recognizing the need to mitigate risk, the Mayo Clinic has incorporated (1) telehealth follow-up for confirmed cases and (2) an in-person clinic for those with respiratory symptoms who tested negative but needed further evaluation [ 8 , 9 ]; by contrast, a drive-through program in Malaysia transported all confirmed cases to their hospital via ambulance [ 13 ]. The use of an algorithm to identify more seriously ill patients and linkage to primary-care and/or emergency follow-up are essential elements of a drive-through program.…”

“…During the current pandemic, drive-through screening has processed large volumes of patients more efficiently than conventional in-clinic assessment, while reducing potential healthcare exposures and personal protective equipment (PPE) use [ 2–15 ]. However, there are limited data regarding patient characteristics or outcomes in the drive-through setting [ 8–11 , 15 ]. Brooke Army Medical Center (BAMC) (San Antonio, TX) implemented drive-through screening for SARS-CoV-2 in March 2020.…”