Patient flow, triage and COVID-19 risk reduction at local clinics

WORLAND – Much remains unclear about the novel coronavirus 2019 (COVID-19), with interrelated questions still unanswered about its means of transmission and degree of transmissibility, its actual prevalence in the community and its lethality.

One thing that is known is that health care providers must do their utmost to protect not only their patients but themselves and their staff from COVID-19 and other infectious diseases. Because almost everything about COVID-19 is uncertain, medical clinics in the Big Horn Basin have taken serious measures to optimize the safety of their patient flow and triage – far beyond those of their pre-COVID-19 clinical precautions.

What kinds of things are local clinics doing differently? How have patients responded?

Banner Medical Group clinics have modified their procedures. According to Anna Venable, Practice Manager for that organization in northwest Wyoming, including Worland, several different protocols are used, depending on patients’ health conditions.

Patients coming for routine wellness visits must wear a mask when they come to the clinic. If they do not have a mask, the clinic provides one. Patients are seen beginning at 7:30 a.m. on weekdays, and come through the clinic’s front door on Howell Avenue.

However, if patients are experiencing respiratory symptoms, they are asked to come to the clinic after 1 p.m. When they arrive, they are asked to call the clinic, and wait in their vehicles. Nursing support staff come to greet the patients, give them face masks and hand sanitizer gel, and escort them in through the clinic’s north side entrance.

Oncology patients use the clinic’s south side entrance. They are greeted at the door, given a mask if they don’t have one and escorted immediately into a patient room.

With regard to the surgical clinic, non-elective procedures are still being performed. Patients come to the main hospital entrance where they are given masks and shown the way to the clinic.

Where possible and appropriate, some patients are seen by means of “telemedicine,” video visits through cameras in their home computers or mobile phones.

Venable says that patients realize the importance of these changes, even if they may be inconvenient. “Our patients and the entire community have been very understanding about the changes and know we are doing everything we can to protect them,” Venable explained. “Our community is amazing.”

Hot Springs County Memorial Hospital CEO Margie Molitor described some of that organization’s patient care protocol adjustments, including those for its clinics in Thermopolis, Worland and Basin.

“If it’s something that can be postponed to a later date, a wellness exam, like your annual wellness exam for Medicare, a well child check, we are encouraging people to not come in to have this done,” Molitor said. “If you’re not sick, we think it’s probably better for you to not come into the clinic.”

Similar to the practice used at Banner clinics, patients seeking care do not simply walk into the lobby. “They drive up to the clinic,” Molitor explained. “There’s a big sign out front that says ‘please call this number when you get here,’ so that they are checking in by phone. We come out to the car and get them and take them in.”

As is being done at Banner clinics, patients with respiratory symptoms, which suggest the possibility of COVID-19 infection, are kept separate from other patients. “If it’s somebody who is symptomatic and ill, we take them into one side of the clinic,” Molitor said. “If they are there for a different reason, we take them into the other side.”

Molitor noted a significant decline in the numbers of patients seeking care in HSCMH’s clinics. However, she pointed out a greatly increased use of telemedicine. “All four of our clinics are doing telemedicine visits when possible,” Molitor said.

How have patients responded to all these changes? In a sign that people all over the Big Horn Basin have their priorities in the right place, HSCMH clinic patient response has been very similar to that of Banner Health patients. “For the most part, people have been very understanding,” Molitor said. “They realize that we’re doing this to protect them.”