How long does it take to remake health care when information is changing by the hour and a panicky public is demanding testing and information?

Turns out that answer is about 48 hours. That’s the amount of time Novant Health took to launch COVID-19 screening centers that dispatched teams of doctors, nurses and other providers into parking lots to start screening and testing patients in North Carolina. At the same time, the organization supercharged its virtual visits -- services that suddenly held a lot more appeal for the public that had been told it was best to stay at home.

Nissen
Nursing leader Nikki Nissen: “Building the plane as you fly is an understatement, you know, for how quickly we were able to do this."

“Building the plane as you fly is an understatement, you know, for how quickly we were able to do this,” said Nikki Nissen, chief nursing officer for Novant Health Medical Group, comprised of some 600 medical clinics. “There are so many details that have to happen in so many departments that came together. They’d say, ‘Here's one more detail you're not thinking of and here's how we can meet that need.’”

Sitting in a former medical practice converted into a virtual visit and COVID-19 screening center almost overnight in Matthews, North Carolina, Nissen explained that everyone quickly realized the traditional time-consuming methods of decision-making had to be set aside for the moment. “This has been a silo-burning mission that we’ve all been on.”

Here’s a high-level overview of how Novant Health providers attacked the COVID-19 in recent days.

Inside the center

The setting is mundane but the scene is not. The Novant Health screening center at 3330 Siskey Parkway in Matthews is nestled in a retail strip center that looks like scores of others across Mecklenburg County. But check the parking lot and you’ll see mask-clad doctors and nurses huddled outside cars talking with anxious patients. It would have been unthinkable six weeks ago. At the moment, Novant Health has seven screening centers up and running.

Inside there’s no painting or posters on the walls of the sparsely appointed building, which was occupied in a matter of hours. “We got the keys on Thursday and we had it opened on Friday (March 13),” said Pam Norton, director of clinic services for the medical group. “There was such a rallying of the troops. So many who said, ‘I’m willing to come and stand next to someone who might have COVID-19.’” Many physician leaders have also joined the front lines, setting their administrative duties aside to join the fight.

As an administrator, Norton’s typical workday uniform is business attire and heels, but today she’s in the trenches wearing scrubs. “You can’t make the right decisions unless you’re out here,” she said. The details were endless and tricky. Mundane processes like patient workflow suddenly aren’t so mundane when you’re treating patients in parking lots and explaining testing protocols for a scary new disease many of us are just starting to comprehend.

Video visits are catching fire

While there’s long been optimism around the value of virtual visits, it’s been slow to catch on for several reasons. The biggest may be the lack of coverage by insurance companies. But doctors and patients have been wary as well. Because of COVID-19, the revolution may be officially underway. Novant Health was averaging less than 20 virtual visits a day in early March. Fast forward to March 23-24 when providers conducted 3,776 virtual visits over the two-day period.

Sherry Dunevant, senior director for training, was in charge of “just in time” training to bring squadrons of doctors and nurses up to speed on the latest capabilities around virtual visits. About half the calls are around COVID-19 questions and concerns, while the other half are more routine visits for patients with chronic conditions, while others just need a prescription refill or treatment for a relatively minor condition.

NP Zoe Comer
Nurse practitioner Zoe Comer has been handling a steady stream of virtual visits since the arrival of COVID-19. Dr. Jacques Laguerre has been treating patients at the center and running virtual visits as well.

Nurse practitioner Zoe Comer has been with patients on video calls day after day and said most patients and providers are catching on fast. If someone gets stuck, she calls and talks them through it. “I think it's going to allow the general public to feel a little bit better about choosing these options, once they have that first-time experience. It’s a privilege to be doing this. I think it's definitely going to be the next wave of our future in providing care and access.” The latest option is TytoHome, where patients can connect to a Novant Health provider who can virtually examine the heart, lungs, skin, ears, throat and abdomen from wherever they are – potentially eliminating a rush to the emergency room or the doctor’s office.

Doctors restoring calm

Dr. Ray Feaster said one of the biggest roles physicians have played is helping calm patients who roll into the parking lot panicked about their symptoms, armed with bad or incomplete information, and worried about what’s next. “A lot of people come in expecting to be tested,” she said, when in fact they don’t meet the criteria established by the Centers for Disease Control and Prevention. A few are angry and many get frustrated, and she gets it. The vast majority of patients, however, are able to center themselves and are relieved when they realize they don’t need testing.

Dr. Jacques Laguerre never imagined treating patients from their car window, or talking them out of a panic during a video visit. But it feels good to be a part of the effort, he said. “Everyone really rolled up their sleeves and made this happen,” Laguerre said. “We had to put a lot of things together, there was a lot of thinking on the fly and having to make some really important executive decisions.

“You know, I think it's very important for us as humans and as medical providers to be out here to take the opportunity to educate our patients through this crisis to reassure and comfort them.”

Top photo: Novant Health team members make their way to another patient car at a COVID-19 screening center on March 24, 2020. From left: Maribel Burgos, certified medical assistant, Gretchen Sweet, nurse, and Brittney Liddic.

Covid-19 Matthews leaders
A lull in the action for leaders at the COVID-19 clinic in Mattews. From left Sherry Dunevant, Pam Norton, Dr. Ray Feaster and Dr. Jacques Laguerre.
 

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