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Vaccine rollout 
My two cents as an emergency physician.
Emergency departments face many logistical and operational challenges & our expertise can inform vaccine campaigns:
Uncertainty
Urgency
Surges
Unscheduled care
Acuity based triage
Safety net care delivery
My two cents as an emergency physician.
Emergency departments face many logistical and operational challenges & our expertise can inform vaccine campaigns:
UncertaintyUrgencySurgesUnscheduled careAcuity based triageSafety net care delivery
To begin with, emergency physicians view this as a 24/7/365 emergency!
In the ED, we drop everything and run to help patients in extremis.
For COVID19, we know that preventing infection is our best shot at saving lives. Every single day of delay leaves patients at risk. https://twitter.com/amychomd/status/1313489215448125441
In the ED, we drop everything and run to help patients in extremis.
For COVID19, we know that preventing infection is our best shot at saving lives. Every single day of delay leaves patients at risk. https://twitter.com/amychomd/status/1313489215448125441
Clearly, vaccine is a precious and limited resource right now. We do not want to waste a single dose.
But another way to think of waste is the waste from vaccine sitting in freezers and the delay between receipt of vaccine and administration in arms.
But another way to think of waste is the waste from vaccine sitting in freezers and the delay between receipt of vaccine and administration in arms.
Every freezer day means another day of delay in immunity.
It means:
More infections
More death
A longer pandemic
We need to be vaccinating urgently. We need to get doses into arms as soon as they are available. https://twitter.com/walidgellad/status/1346408220307419140
It means:
More infections
More death
A longer pandemic
We need to be vaccinating urgently. We need to get doses into arms as soon as they are available. https://twitter.com/walidgellad/status/1346408220307419140
Offices typically schedule patients in an orderly way. It usually leads to decreased wait times for patient and less overtime or weekend/holiday expenses.
Emergency departments are used to dealing with surges, uncertain arrivals and 24/7/365 operations with lean resources.
Emergency departments are used to dealing with surges, uncertain arrivals and 24/7/365 operations with lean resources.
An orderly, bankers hours rollout is likely going to be slow.
Push (a line of eager customers waiting) typically works much faster than pull (controlled by the one providing services).
While seemingly more orderly, appointments add work and make the line move more slowly.
Push (a line of eager customers waiting) typically works much faster than pull (controlled by the one providing services).
While seemingly more orderly, appointments add work and make the line move more slowly.
Another issue we deal with in the ED is triage. We triage by acuity in the ED first - not arrival time, insurance status or power.
Patients hate it when they get triaged behind another who arrived behind them. But we hold to our egalitarian standards.
So we work to...
Patients hate it when they get triaged behind another who arrived behind them. But we hold to our egalitarian standards.
So we work to...
...alleviate this problem in a few ways:
We work faster when there is a line.
We work fast even when their is no line, knowing that a line could show up at any time.
We utilize âsplit flowâ to work in parallel. Eg patients with low resource needs can go to a fast track.
We work faster when there is a line.
We work fast even when their is no line, knowing that a line could show up at any time.
We utilize âsplit flowâ to work in parallel. Eg patients with low resource needs can go to a fast track.
*there not their
My suggestions to hasten rollout:
Start measuring and reporting vaccine freezer days by provider.
If you donât measure it, it wonât drive performance. If you penalize for making mistakes but you donât encourage speed, you will end up with a slow rollout.
Start measuring and reporting vaccine freezer days by provider.If you donât measure it, it wonât drive performance. If you penalize for making mistakes but you donât encourage speed, you will end up with a slow rollout.
Hurry up with vaccinating LTC residents. These patients are at incredible risk. If pharmacy partner canât get first doses in quickly, give the vaccine to the LTC staff or another organization that can do it faster.West Virginia got it done. https://www.cnbc.com/2020/12/22/covid-vaccine-west-virginia-gov-jim-justice-on-nursing-home-rollout.html?fbclid=IwAR3FhnE4v53NoxHfd_Fq5347Htut9KCg6DQ8Xa1XS_uRmEbnELLf1vhvh1g
Open up community vaccination sites and move on to vaccinating next tiers if you have any vaccine in freezers. Donât wait to get through the first priority. Oklahoma stood many of these community âPODSâ up within days. https://www.koco.com/article/covid-19-vaccine-distribution-sites-planned-as-oklahoma-moves-to-phase-2/35101107
Move quickly to open access to the next phase (teachers please!) To ensure priority access, you could use a âDisney Fast Passâ type system. Lower tiers can line up and wait to see if there is enough, but if you are a higher tier you can go to the head of the line.
Use honor system to move through after the first groups (who have badges.) Washington is going to be doing this. Donât force vaccinators to police it - it will slow down the line and discourage volunteers. https://twitter.com/seattletimes/status/1345223514694017024?s=21
Donât waste time on scheduling. Simple off the shelf scheduling software like signup genius for âcrowd control.â No vaccine goes to waste, even if that means vaccinating an eager lower tier patient with the leftover.
Share and learn from best practices to enable flexibility and speed in setting up and running an event when you get a shipment of vaccine. Standardized guidelines or operations manuals will help make this easier and faster in the future. Remember that freezer days are waste.
Worry less about the order of the line and who is worthy and more about moving the line faster. https://twitter.com/farzad_md/status/1344341150090584064?s=21People are less likely to cut or get angry if wait is shorter and line is moving fast.
Let primary care clinics be involved. They have a lot of expertise with annual influenza campaigns and clinics and could help speed this up.
All of those ideas are how we get vaccines out via the âfast track.â
The bigger challenge will be getting vaccines to those without healthcare homes, stable housing, documents, time off to travel or wait in line or transportation.
The bigger challenge will be getting vaccines to those without healthcare homes, stable housing, documents, time off to travel or wait in line or transportation.
It is incredibly important to invest our time and resources in bringing vaccines to the groups that are most vulnerable because they work in environments where risk is unmitigated and often also live in multigenerational or crowded housing where isolation is impossible.
