Creating an Ambulatory Care Infusion Space (ACU) for Symptomatic Patients Under Investigation (PUI) and Confirmed COVID-19 Positive Cancer Patients

Significance and background: The COVID-19 pandemic posed unprecedented global challenges that countries and healthcare institutions were not fully prepared to face with a magnitude of this level. In the wake of this crisis, healthcare organizations had to reorganize their systems and processes at a rapid pace in response to the complexities brought by this pandemic.

Purpose: One of the difficulties hospitals face is balancing the management of COVID-19, while delivering care for other serious medical cases. Although non-emergent treatments and procedures were paused, chronic diseases could not be ignored because delaying or deferring treatments could be detrimental to a patient’s prognosis, like cancer. Despite the threats of this virus, the ambulatory care treatment center (ATC) aimed to prevent disruptions in oncology care with the development of a dedicated treatment space for patients with a suspicion or confirmed diagnosis of COVID-19.

Intervention: The organization focused on three goals: protect our vulnerable patients, ensure the health of our workforce, and minimize community spread. Using these goals as guiding principles, the COVID-19 core leadership team (CCLT) and the ATC leadership created an infusion space, acute care unit (ACU), for symptomatic PUI or COVID-19 + patients that required emergent treatment or testing before completing 20 days of quarantine. This space was converted into two zones: yellow zone for symptomatic PUI and red zone for confirmed positive cases. Infrastructural changes included visual cues to identify these high-risk zones and creating spaces in working areas that adhered to social distancing requirements. Dedicated staff were selected to work in the two areas to prevent cross-contamination and received education and training on managing patients with infections. A workflow process was developed to include a designated screening/check-in area, elevator, entry and exit points, with patients being personally escorted for arrivals and discharges to minimize exposure areas. The ACU also provided physicians and advanced practice providers (APP) a space to perform outpatient procedures as needed for this patient population. Managing and protecting the healthcare team was also crucial because of the increased risk of exposure.

Evaluation: Managing and protecting patients, healthcare teams, and visitors is extremely crucial do to increase risked of exposure with COVID-19 positive patients. The ACU has treated an average of 3-5 patients per day, with no incidents of staff infection while providing care. Additionally, there were no incidents of nosocomial infections to other patients due to having designated routes to ACU specifically for COVID positive patients.

Discussion: COVID-19 continues to overwhelm the healthcare environment. Organizations strive to learn from this experience and strategize effectively to manage and eventually recover from this crisis. These lessons learned will help organizations prepare for any future outbreaks resulting in a pandemic.