Drive-Through Medicine: A Novel Proposal for Rapid Evaluation of Patients During an Influenza Pandemic
Received 24 August 2009; received in revised form 15 October 2009 and 2 November 2009; accepted 20 November 2009. published online 18 January 2010.
Study objective
During a pandemic, emergency departments (EDs) may be overwhelmed by an increase in patient visits and will foster an environment in which cross-infection can occur. We developed and tested a novel drive-through model to rapidly evaluate patients while they remain in or adjacent to their vehicles. The patient's automobile would provide a social distancing strategy to mitigate the person-to-person spread of infectious diseases.
Methods
We conducted a full-scale exercise to test the feasibility of a drive-through influenza clinic and measure throughput times of simulated patients and carbon monoxide levels of staff. We also assessed the disposition decisions of the physicians who participated in the exercise. Charts of 38 patients with influenza-like illness who were treated in the Stanford Hospital ED during the initial H1N1 outbreak in April 2009 were used to create 38 patient scenarios for the drive-through influenza clinic.
Results
The total median length of stay was 26 minutes. During the exercise, physicians were able to identify those patients who were admitted and discharged during the real ED visit with 100% accuracy (95% confidence interval 91% to 100%). There were no significant increases of carboxyhemoglobin in participants tested.
Conclusion
The drive-through model is a feasible alternative to a traditional walk-in ED or clinic and is associated with rapid throughput times. It provides a social distancing strategy, using the patient's vehicle as an isolation compartment to mitigate person-to-person spread of infectious diseases.
Department of Surgery/Division of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
Address for correspondence: Eric A. Weiss, MD, Division of Emergency Medicine, Stanford University School of Medicine, 701 Welch Rd, Building C, Palo Alto, CA 94304; 650-725-4923, fax 650-723-0120
Supervising editor: Ellen J. Weber, MD
Author contributions: EAW, JN, and GHG conceived the study. EAW, JN, GHG, and JVQ designed the trial. EAW, JN, and GHG supervised the conduct of the trial and data collection. JVQ provided statistical advice on study design and analyzed the data. EAW drafted the article, and all authors contributed substantially to its revision. EAW takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
Reprints not available from the authors.
Please see page 269 for the Editor's Capsule Summary of this article.
Publication date: Available online January 15, 2010.
ABSTRACT