Kurt Forsthoefel

This year has seen significant changes and uncertainty within the ambulatory care setting. The COVID-19 pandemic has reshaped and challenged healthcare organizations, forcing them to refocus or fast-track existing or new initiatives and to explore new solutions and technologies.

The current disruption of workflows and how caregivers engage patients is completely upending traditional clinic environments including the people, processes, and equipment in them. Many of the steps that healthcare organizations are taking now are evolving the point of care and will continue to completely change how care is delivered moving forward.

As a result of the disruption caused by the pandemic, we are seeing a shift in priorities as healthcare organizations adapt to the new normal and work to increase or maintain the quality of care. The three main areas where we are seeing this shift occur involve healthcare being delivered everywhere, infection prevention, and clinical design. While these areas are not necessarily new priorities, COVID-19 has brought them front and center as organizations urgently focus on the point-of-care experience. These shifts present several opportunities for medical device innovations to support such change.

Healthcare Everywhere

As healthcare organizations work to make the delivery of care more patient-centered and accessible, there is a need for the point-of-care ecosystem to expand both physically and digitally.

Nowhere is this expansion more evident than with the rise of virtual care and telehealth prompted by COVID-19. In many ways, the pandemic has been a breakthrough event for telehealth. With access to care impeded by valid concerns of infection spread among caregiver teams and at-risk patients, virtual access to care was quickly and widely adopted. Nearly all healthcare organizations urgently took steps to maintain the delivery of care while keeping patients and staff safe from viral contagion exposure risk.

To help with integrating technology into traditional clinic ecosystems, many healthcare providers are turning to mobile workstations to provide flexibility and stability and extend the point-of-care ecosystem beyond the four walls of the traditional exam room.

Workstations have been a central and established fixture in most exam rooms for years. With a mobile workstation in play, workflows are streamlined and interactions at the point of care are unobstructed. The platform has proven to be easily adjustable to support all forms of interactions occurring within that space.

Mobile workstations also offer an optimal platform for supporting virtual care. Many mobile workstations currently on the market provide the opportunity for customization to the unique needs of the provider, thus allowing healthcare systems to optimize the platform for their specific telehealth program. Mobile workstations can also easily incorporate advanced technology such as cameras, digital instruments, and expanded monitors. Some of the better mobile workstations on the market provide a wide range of optimization, allowing providers to maintain an ergonomically correct working position, whether seated or standing.

Infection Prevention

The COVID-19 pandemic has brought a new urgency to infection prevention, as healthcare organizations continue to work to keep patients and staff safe and as patients seek assurances that necessary precautions are being taken. Many healthcare organizations are assessing their current infection prevention efforts and identifying areas where additional steps can be taken to enhance their program.

One area of opportunity involves instrument processing. Ideally, the instrument processing space should be a separate, discrete area designed specifically for instrument processing and sterilization. This separation allows for more control and management of the process and helps ensure safety and an efficient workflow.

Regardless of the size or shape of the instrument processing area, there are five critical steps, based on Centers for Disease Control and Prevention guidelines, that should be a part of instrument processing workflow designs. Implementing these steps helps to ensure a smooth dirty-to-clean design for the flow of instruments.

Another infection prevention area healthcare providers are looking at is the traditional manual contact-tracing process. Some are using real-time locating system (RTLS) technology to automate the labor-intensive process of contact tracing, thereby helping to increase the speed, effectiveness, and accuracy of monitoring efforts.

Utilizing RTLS badges and sensors, the technology can automatically track and document patient and staff interactions. Caregivers can simply run a report that helps to immediately identify with whom a patient diagnosed with an infectious disease came into contact, which areas of the facility were visited, and what equipment was used. This allows caregivers to quickly notify, test, and treat those who came into contact with the contagion as well as support decontamination efforts.

Clinical Design

For the past few years, the growing patient population has been putting greater strain on the typical liner design of ambulatory care environments that feature shared corridors and publicly exposed workstations. Hallways were often crowded with equipment, patients, and caregivers; privacy issues would arise; and overall patient experience was impacted. COVID-19 increased that strain, adding concerns of social distancing and infection prevention.

To address these challenges, many healthcare organizations and caregivers are incorporating patient-centered workflow designs. By focusing on the patient, these designs allow caregivers to better manage and limit patient interactions and movement throughout the facility and reduce the potential for exposure or transmission.

Following are three examples of patient-centered workflow designs gaining traction in ambulatory care facilities:

The collaborative care model keeps patients at the center of the care experience by delivering ancillary services within the exam room. Traditionally, patients move through various locations of the facility during visits, often for diagnostic testing or other ancillary services. By allowing patients to remain in one place and consolidating visits as much as possible, care teams are decreasing patients’ overall length of stay while improving access and efficiency. Patients receive services within the same exam room, rather than moving from location to location.

The self-rooming model, supported by RTLS technology, eliminates the waiting room and allows patients to check in and proceed directly to an exam room or diagnostic sub-waiting location. Patients often receive locator badges at check-in, and staff use software to identify which rooms are clean and ready for a new patient. Upon patient entry into the room, the software automatically notifies the care team of their arrival.

The dual access model, which is more easily adoptable with new construction or redesigns, separates caregivers and patients, providing dedicated corridors to dual-entry exam rooms where patients enter through one door and caregivers enter through a different door. Patient corridors and entries offer greater privacy and a calmer environment free from clinical clutter. The staff and clinician entry leads to a centralized clinical work area where caregivers can be collaborative with the entire care team. The clinical work area also provides line of sight to all exam rooms for better flow management.

The COVID-19 pandemic has served as a catalyst for change in ambulatory care, transforming the point of care and how care is delivered. As a result, we are seeing caregivers and healthcare organizations place more emphasis on initiatives, solutions, and technologies. Focusing in these areas promises continuing improvements for the healthcare experience and the quality of care.

Kurt Forsthoefel is director of marketing for Midmark.