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Drive-thru medical experiment conducted at Stanford Hospital and Clinics
By Mark Gomez
Mercury News
San Jose Mercury News
The cars, minivans and sport-utility vehicles began lining up and slowly moving forward, just as they would at a busy fast food drive-thru. But there weren't any burgers or fries on the menu. Instead, drivers and passengers were examined by a team of Stanford doctors and nurses, all without getting out of their cars.
In what is believed to be the first training exercise in the country, a team of health care professionals at Stanford Hospital & Clinics turned the first floor of a parking garage into a drive-through emergency room Friday morning in hopes of creating a more efficient way to treat a large number of patients during an influenza pandemic or other emergency.
Dr. Eric Weiss, medical director for disaster planning at Stanford Hospital and Clinics and Lucile Packard Children's Hospital, believes the drive-through triage can serve as a blueprint for hospitals nationwide and across the globe.
"Everywhere throughout the country, during flu season, emergency rooms are absolutely overwhelmed and bursting at the seams," Weiss said. "With limited health care insurance and people not having primary care physicians, they use emergency departments as their primary care physician. And it's our safety net. We have to have a new mechanism to take care of large numbers of patients during a pandemic and I think that this is going to be it."
Dr. Greg Gilbert, a Stanford clinical professor and medical director for San Mateo County, came up with the idea of a drive-through triage a few years ago while doing pandemic flu planning with Weiss. At first he thought of creating a tent outside the ER, but scrapped that idea that would require people standing outdoors during winter.
The drive-thru idea came to him while resting in bed. He thought "everyone has cars, why not keep them in cars," which would, keep people from infecting others. Weiss said, "We thought this would be a great way to use the automobile as a self-contained contamination.
To make the exercise work, Dr. Jessica Ngo, a clinical instructor at the emergency department and disaster medicine fellow, came up with 35 specific scenarios from real patients who visited the Stanford emergency department in April, when worries about swine flu dominated the headlines. Six volunteers were "sick" enough to be admitted to the hospital. The others were given specific information about their conditions, including age, gender, a detailed list of symptoms and previous medical history.
"This was what was presented to the emergency room," Ngo said.
Zeroing on the current H1N1 epidemic, one of the scenarios called for a young boy who had a sore throat, runny nose and cough for two days, and worried parents. Though the boy had no fever, headache or vomiting ? all key symptoms of swine flu ?his parents were concerned that he had come into contact with somebody who had recently visited Mexico.
Wendy Shray played the role of the worried mother and volunteered her 7-year-old son, Aaron, to pretend to be the ill boy. Shray's 11-year-old daughter Julia also participated in the event.
"I think the drive thru is a great idea," Shray said. "You're comfortable in your car. If you're not feeling well, you don't have to get out and walk. Plus, if you don't have it and somebody else does, you're not exposing yourself."
The volunteer patients made their way through the drive-thru triage as though they were being seen at the emergency room. As cars entered the parking garage, patients registered and were given paperwork. They then drove through one of two lines and stopped at the first station, triage, where nurses and emergency department technicians checked for vital signs ? temperature, heart rate, blood pressure and respiration ? and gathered the patients' medical backgrounds. Doctors, nurses and other medical staff wore gowns and gloves throughout the exercise.
From there, patients drove another 10 to 15 feet for a medical screening exam, where doctors reviewed the symptoms and made a diagnosis. Finally, they were discharged or admitted to the hospital.
During the exercise, a team of physicians and medical staff observed and evaluated the process. Over the next several days, Stanford doctors will review the data and try and find ways to streamline the process. The results will likely be published in a journal and begin to spread through the medical community, Gilbert said.
"We will determine the times and see how much faster we were than we would be in a typical setting when patients come into emergency departments and go to examination rooms," Weiss said. "I think we're going to find this is much faster, just as effective and look at how we can make even it more efficient."
Contact Mark Gomez at mgomez@mercurynews.com or 408-920-5869.
http://www.mercurynews.com/portlet/article/html/fragments/print_article.jsp?articleId=12580052&siteId=568
By Mark Gomez
Mercury News
San Jose Mercury News
The cars, minivans and sport-utility vehicles began lining up and slowly moving forward, just as they would at a busy fast food drive-thru. But there weren't any burgers or fries on the menu. Instead, drivers and passengers were examined by a team of Stanford doctors and nurses, all without getting out of their cars.
In what is believed to be the first training exercise in the country, a team of health care professionals at Stanford Hospital & Clinics turned the first floor of a parking garage into a drive-through emergency room Friday morning in hopes of creating a more efficient way to treat a large number of patients during an influenza pandemic or other emergency.
Dr. Eric Weiss, medical director for disaster planning at Stanford Hospital and Clinics and Lucile Packard Children's Hospital, believes the drive-through triage can serve as a blueprint for hospitals nationwide and across the globe.
"Everywhere throughout the country, during flu season, emergency rooms are absolutely overwhelmed and bursting at the seams," Weiss said. "With limited health care insurance and people not having primary care physicians, they use emergency departments as their primary care physician. And it's our safety net. We have to have a new mechanism to take care of large numbers of patients during a pandemic and I think that this is going to be it."
Dr. Greg Gilbert, a Stanford clinical professor and medical director for San Mateo County, came up with the idea of a drive-through triage a few years ago while doing pandemic flu planning with Weiss. At first he thought of creating a tent outside the ER, but scrapped that idea that would require people standing outdoors during winter.
The drive-thru idea came to him while resting in bed. He thought "everyone has cars, why not keep them in cars," which would, keep people from infecting others. Weiss said, "We thought this would be a great way to use the automobile as a self-contained contamination.
To make the exercise work, Dr. Jessica Ngo, a clinical instructor at the emergency department and disaster medicine fellow, came up with 35 specific scenarios from real patients who visited the Stanford emergency department in April, when worries about swine flu dominated the headlines. Six volunteers were "sick" enough to be admitted to the hospital. The others were given specific information about their conditions, including age, gender, a detailed list of symptoms and previous medical history.
"This was what was presented to the emergency room," Ngo said.
Zeroing on the current H1N1 epidemic, one of the scenarios called for a young boy who had a sore throat, runny nose and cough for two days, and worried parents. Though the boy had no fever, headache or vomiting ? all key symptoms of swine flu ?his parents were concerned that he had come into contact with somebody who had recently visited Mexico.
Wendy Shray played the role of the worried mother and volunteered her 7-year-old son, Aaron, to pretend to be the ill boy. Shray's 11-year-old daughter Julia also participated in the event.
"I think the drive thru is a great idea," Shray said. "You're comfortable in your car. If you're not feeling well, you don't have to get out and walk. Plus, if you don't have it and somebody else does, you're not exposing yourself."
The volunteer patients made their way through the drive-thru triage as though they were being seen at the emergency room. As cars entered the parking garage, patients registered and were given paperwork. They then drove through one of two lines and stopped at the first station, triage, where nurses and emergency department technicians checked for vital signs ? temperature, heart rate, blood pressure and respiration ? and gathered the patients' medical backgrounds. Doctors, nurses and other medical staff wore gowns and gloves throughout the exercise.
From there, patients drove another 10 to 15 feet for a medical screening exam, where doctors reviewed the symptoms and made a diagnosis. Finally, they were discharged or admitted to the hospital.
During the exercise, a team of physicians and medical staff observed and evaluated the process. Over the next several days, Stanford doctors will review the data and try and find ways to streamline the process. The results will likely be published in a journal and begin to spread through the medical community, Gilbert said.
"We will determine the times and see how much faster we were than we would be in a typical setting when patients come into emergency departments and go to examination rooms," Weiss said. "I think we're going to find this is much faster, just as effective and look at how we can make even it more efficient."
Contact Mark Gomez at mgomez@mercurynews.com or 408-920-5869.
http://www.mercurynews.com/portlet/article/html/fragments/print_article.jsp?articleId=12580052&siteId=568