Stanford Medicine creates clinic to test its employees for coronavirus, offer counsel

When his supervisor approached him about working at a clinic to test employees who might have contracted COVID-19, Scott Gordon, RN, a Stanford Life Flight nurse, didn’t hesitate, despite potential exposure to the virus. He wanted to help his co-workers.

“It was a calculated risk, but I take calculated risks in my primary job,” said Gordon, whose work treating trauma patients as they’re transported by helicopter to a hospital often puts him in dangerous situations. 

Still, it can be stressful on the front lines of testing in a pandemic. “It’s tough emotionally already, but it can be tougher when you see colleagues you know and work with on a daily basis come in, and they’re ill,” he said. 

Gordon is part of a new operation that serves Stanford Medicine employees, no matter their roles, during the COVID-19 pandemic. It consists of the new Occupational Health Respiratory Evaluation Center, or OH-REC, and the new Occupational Health Telephone Evaluation Center, or OH-TEC, both of which opened just two weeks after conception. 

“It’s just stunning that we have been able to create a whole new stand-alone clinic so quickly,” said Lisa Schilling, RN, MPH, vice president of quality, safety and clinical effectiveness at Stanford Health Care. “We did this because we want to take care of the people who are caring for patients.”

Stanford Medicine leaders had been monitoring data about COVID-19, which is caused by the coronavirus, as it spread around the globe. By March 1, they realized it was time to step up preparations. 

“We could see from epidemiology information and the news from around the world it was big, and it was going to get bigger,” said Shelagh Nolan, RN, director of quality management at Stanford Health Care.

Stanford Medicine leaders knew that preparations had to start with making sure health workers would be safe when the coronavirus swept in to the Bay Area. 

“Before we can even take care of the patients, we have to take care of our health care workers,” said Karen Jazmin, RN, a clinic operations manager at Stanford Health Care. “That’s one of the driving forces in this.” 

It’s just stunning that we have been able to create a whole new stand-alone clinic so quickly.

The first thing Schilling’s team realized was that occupational health and safety services, which functions within human resources at Stanford Health Care, wasn’t designed to handle a large-scale crisis and would soon be overwhelmed by calls from worried workers that were already coming by the hundreds.

“We could see that what we have, while it’s good under ordinary circumstances, couldn’t cope with this,” Nolan said.

So the team developed the separate nerve center — under the purview of Stanford Medicine’s quality, safety and clinical effectiveness group  — to manage pandemic-related  workforce concerns and illnesses.

Through their combined efforts, the new call center and clinic provide COVID-19 services — from initial screening and testing to giving advice about returning to work — for employees at Stanford Health Care, Stanford Children’s Health and the Stanford School of Medicine. (Stanford Health Care – ValleyCare manages testing and other COVID-19 services for its employees.)

Schilling’s team set three goals in setting up the operation: offer rapid screening and testing for the virus, provide workers with information about protecting themselves, and create an electronic medical record system for employees affected by the virus. 

Open for business

Each step in the process could easily take weeks to accomplish. But, Schilling said, with unwavering support from Stanford Medicine leaders and a small army of people in nearly every department, the clinic was up and running on March 12, several days before six Bay Area counties issued stay-at-home orders to head off the virus.

Speeding up screening and testing was aided by the development of a COVID-19 diagnostic test in early March in a Stanford School of Medicine researcher’s lab, and by help from Stanford Health Care’s patient experience team in triaging employee calls until the new call center was in place. 

Creating an electronic medical record portal for sharing test results and other COVID-19 information with affected employees wasn’t as simple. To protect employee privacy, occupational health services keeps paper charts. Those had to be computerized for the pandemic response, and an information technology team needed to integrate them with the research operation so scientists could better understand the virus and how to treat patients infected with it.

“It was unprecedented, what we had to do,” Schilling said of converting the paper charts to a digital format. “Literally, when we walked in on that Monday, we saw stacks of paper.”

The project development team had to find space for the new respiratory evaluation clinic. One thought was to erect drive-through tents, but by March 10 they had decided to co-opt empty space in the original Stanford Hospital building. The following day, facilities workers were painting, having already scrubbed down the walls, retrofitted the space, mapped out furniture placement so everyone would be safe, fixed air flow and stocked the rooms with supplies.

Next came the opening of the call center, where nurses answer questions, offer advice about the illness, conduct initial assessments and schedule further screening and testing appointments as needed. The first center was in a conference room, but as the number of calls and staff grew, it was moved to office space to allow for social distancing.

On March 13, a Friday, the team began testing at the clinic, then spent the weekend working out kinks. IT workers spent March 15 putting the first phase of the electronic record-keeping system in place, doing in one day what usually takes four to six weeks, Jazmin said. 

The next day the respiratory evaluation clinic was officially open for business.

The integration of the electronic health care system for workers with the data collection operation was completed the first week of April.

Caring for the workers

In the first few days, about 4,000 phone calls were fielded, said Jazmin, who manages the clinic. As of April 13, 2,600 employees had been tested and only 3% of them were positive for COVID-19. By comparison, nearly 9% of tests on symptomatic people in surrounding communities came back positive, and 10-20% of tests on health care workers across the country did, Schilling said.

Besides being screened and tested at the center, workers are counseled about what to do while they wait for test results — primarily, to go home and stay isolated from other people until they know if they have the illness. Workers who test positive for COVID-19 are then advised about how to monitor their health at home, what to do if their symptoms worsen, and the steps required before they can go back to work.

The clinic also advises workers caring for patients on how to protect themselves at work, such as when to wear masks or other personal protection equipment, said Amy Semple, administration director for operations for interventional platforms. 

“It’s a very scary time for taking care of people,” she said, adding that worried workers need information in real time.

A crisis response

Nolan and others said that units across Stanford Medicine — facilities, information technology, clinical staffing, operations, emergency services and many more — gave everything they could to bring the project together. 

“Everybody has stayed up late, come in early and broken all kinds of barriers of speed records to get stuff done, and they did it without any cutting corners,” Nolan said. “There’s this sense of good cheer and camaraderie in this mission of taking care of ourselves and our colleagues with this work that has really just brought out the best in everybody. Literally everybody we called has done anything they could to help us right now.”

There’s this sense of good cheer and camaraderie in this mission of taking care of ourselves and our colleagues.

Jazmin said that the creation of the center felt almost like erecting a mobile army surgical hospital, in which first responders create pop-up units to respond to earthquakes, wildfires or other disasters — then take them down when the crisis has ebbed. 

“You set up quickly to address the need, the demand and the problem,” Jazmin said. “And when this is all over, we fold up, pack up and go back to our old lives.”

What’s left is a blueprint for the next crisis — one that has proven to be nimble enough to expand and grow as needed.

Though she knows the work is far from finished, Schilling said she’s proud of Stanford’s response to one of the worst health crises in modern history. 

“When the book is written on the world’s response to the COVID-19 pandemic, I always think about what the world will say Stanford did in response,” she said. “I don’t think society as a whole was quick enough to respond. But Stanford was proactive from the beginning. We made sure our people were well cared for so they could care for others.”

Like the rest of Bay Area residents, though, she is watching for a possible surge in cases.

“I think we’re all really waiting for the day this is all over,” she said. “One of the worst aspects of this is that we’re still in the early phase. But I think Stanford is as prepared as it can be.”