Response rises from lessons of South Dunedin floods
The Covid19 challenge brought sudden and lasting change at the front line of the public health response, writes Dr Jill McIlraith , of Aurora Health Centre in South Dunedin.
General Practice changed dramatically, and probably forever, over Otago Anniversary weekend.
We knew the coronavirus was spreading rapidly and would impact us. We prepared well, drawing on our experience of the 2015 South Dunedin floods when Aurora Health Centre was the only practice affected. We came through that by quickly adapting to working differently, teamwork, keeping our sense of humour, and caring for our patients and ourselves. We had emerged as a stronger, more cohesive practice with a strong commitment to our nearly 6000 patients and to training the next generation of GPs.
But then came the bombshell on Saturday,
March 21: with two days’ notice, general practices were expected to lock their doors and deal with most patients by phone or video calls with the goal of reducing facetoface consultations by at least 70%.
In a normal day, we would have more 100 patients through our clinic for facetoface consultation. Our waiting rooms are a meeting place of the well, the worried, those with chronic conditions, trauma and accidents as well as driver’s licence and employment medicals — and the very sick.
But with Covid19, the mixingpot of general practice put everyone at risk.
Sunday and then Otago Anniversary Day were spent phoning dozens of patients who already had appointments, finding webcams, setting up remote access, and working out a phone triage system: all patients were designated as ‘‘green’’ (well with no indication of infection), ‘‘orange’ (those with colds, coughs and sore throats, probably not Covid19 but could be) and ‘‘red’’ (those at most risk of Covid19).
Overnight, we had to become experts at screening patients on the phone. We turned off our online booking system, shut down the checkin kiosk and removed two out of three waiting room chairs so that even ‘‘green’’ patients allowed in were seated far from each other.
Young doctors and nurses rose to the challenge by designing systems to keep everyone safe, reorganising rosters so atrisk colleagues (older doctors and those with preexisting conditions) were not doing Covid19 swabs but would still do remote phone triage and consultations.
A rented cabin (from the same company we’d used during the 2015 floods) with walkietalkie access was set up so we would have somewhere weatherproof, but outside the main practice, to see ‘‘red’’ patients. Drivethrough swabbing sessions and flu clinics were organised and plans were made to manage our frequent presenters and most vulnerable patients.
Reception staff got very good at explaining the new systems and dealing with anxious patients whose anxiety often manifested as anger, demanding their flu vaccines quicker than they could be delivered.
While trying to keep 2m apart, we held regular corridor staff meetings so we all knew what was going on — and then had to dish out throat lozenges as everyone got hoarse from talking loudly and nonstop on the phones. A noticeboard outside the nurses’ rooms became crucial for keeping pace with the very rapid changes — as of Easter we were up to Version 15 of the primary care guidelines for Covid19 management. We set up a practice WhatsApp to share tips, the latest information streaming in and to support each other.
During the six months recovering from the floods, we quickly realised that if we stayed calm, shared out jobs and kept a sense of perspective, everyone coped better.
Now, with Covid19, we still share wacky moments such as a patient giving us a large bottle of liqueur ‘‘to make things go more smoothly’’, who has the worst homedone haircut and who looks the most alien in PPE gear while practising car park medicine. Colourful homemade surgical caps and 3D printed face masks (sourced by our young doctors from community volunteers) now go with the scrubs.
We will continue to be reliant on the phone for triage and consultations with increasing video usage. They will become an integral part of all general practice in NZ and will be well embedded as we face waves of infection over the next few years.
Many patients like phone consultations but we will still need to do facetoface consultations for the more vulnerable, the less techsavvy and those who need physical examination. Getting the balance right between virtual and inperson interactions will be tricky, but it may be one positive contribution Covid19 makes to general practice.
Another is how well young doctor and nursing colleagues have shouldered the mantle of coping with their world being upended and embraced its daily challenges. They are the future of primary care. We need to nurture and support them in remodelling general practice in this unchartered world.