Patient and Resource Management of Emergency Walk-In Clinic During a COVID-19 Pandemic State Lockdown

Figures & data

Table 1 Measures Taken During the COVID-19 Pandemic State Lockdown

Administrative and resource management	•Cessation of non-emergent services and elective surgeries to decrease clinic volume
	•Contact patients via phone call to cancel or reschedule clinic appointments
Environmental control	•All patient visits took place in the first-floor clinics
	•All people entering the building were funneled through one entry point
	•All were required to sanitize hands with ethyl alcohol 70% upon entry
	•Chairs in the common areas were spaced 6 feet apart
	•Patients were evaluated individually, no companions allowed to come unless required
	•Isolation rooms were designated for the evaluation of COVID-19 suspected or confirmed positive cases
	•Transparent protective shields were installed on slit lamps
	•Exam rooms were disinfected using diluted sodium hypochlorite after each patient
	•Equipment such as slit lamps was disinfected using 70% ethyl alcohol after each use
	•Tonometry with disposable covers was used to measure intraocular pressure
Screening and Triaging	•All were required to complete a COVID-19 symptom questionnaire before entering the clinical area.
	•Those positively screened for COVID-19 symptoms without an urgent ophthalmic complaint were directed to go home and contact their primary care provider or seek care at the nearest emergency department
	•Triaging was in accordance with the published guidelines by the American Academy of Ophthalmology for urgent and non-urgent reasons for evaluation
	•Non-urgent cases encouraged to reschedule the appointment for a later date
	•Urgent cases proceeded to an exam room for evaluation
Staff Protection and Personal Protective Equipment	•Healthcare workers were instructed to wear a surgical mask or N95 masks at all times.
	•The evaluating physician was encouraged to use masks, gloves, and eye protection for all encounters
	•Patients were encouraged to wear masks
	•Urgent cases that were positive on COVID-19 screening were immediately placed in the designated isolation rooms. Evaluating ophthalmologist was recommended to wear an N95 mask, gown, gloves, and eye protection

Table 2 Demographic Information

Age	Range: 18–94 yo	Min: 18 yo	Max: 94 yo	Mean: 54.2 yo
Sex	Male: 42.8%	Female 57.2%
Race	African: 73.8%	White 15.7%	Other: 10.5%
Comorbidities	HTN: 53.7%	Diabetes: 29.3%	COPD:7.0%	CHD:6.6%	KD:8.3%

Note: Other: Asian, Latino, Middle Eastern, Native Hawaiian, patients that did not disclose.

Abbreviations: HTN, hypertension; KD, kidney disease; CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; yo, years old.

Table 3 Chief Complaints

Chief Complaint	Frequency	Percent
Acute vision change	90	39.3%
Acute pain-irritation-itching	91	39.7%
Post-operative examination	86	37.5%
Acute external adnexa issue	60	26.2%

Table 4 Most Common Diagnoses

		Frequency
Diagnosis	Vitreous hemorrhage	10
	Corneal ulcer	9
	Retinal detachment	9
	Primary open angle glaucoma	8
	Chalazion	8
	Corneal abrasion	8
	Foreign body of the cornea	8
	Dry eye	7
	Viral conjunctivitis	7
	Ruptured globe	6
	Age related macular degeneration	5
	Traumatic iritis	4
	Proliferative diabetic retinopathy	4
	Posterior vitreous detachment	4
	Vitreous floaters	4
	Nuclear sclerosis	4
	Age related cataract	4

Table 5 Diagnosis: Category of Eye

		Frequency	Percent
Category	Cornea	61	31.4
	Vitreo-retinal disease	49	25.3
	Orbit/eyelid	17	8.8
	Glaucoma	17	8.8
	Lens	16	8.2
	Uveitis	16	8.2
	Trauma	11	5.7
	Neuro-ophthalmology	7	3.6
	Total	194	100.0

Table 6 Office Procedures

		Frequency	Percent
Type	Anti-VEGF	12	37.5
	Foreign Body Removal	7	21.9
	Pan-retinal Photocoagulation	7	21.9
	Placement of bandage contact lens	2	6.3
	Corneal culture and plate	1	3.1
	Epilation	1	3.1
	Bleb needle revision	1	3.1
	Suture removal	1	3.1
	Total	32	100.0

Table 7 Surgical Procedure

		Frequency	Percent
Type	Vitreo-retinal surgery*	11	73.3%
	Keratoplasty	2	13.3%
	Ruptured globe repair	1	6.7%
	Temporal artery biopsy	1	6.7%
	Total	15	100.0

Note: *Pars plana vitrectomy, membrane peel, endolaser, C3F8 gas, scleral buckling, silicon oil, retisert.

Table 8 Correlation Between Positive COVID Cases in Detroit and Clinic Visits

Type of Clinic Visit	r Value	p value
Total cases per week	−0.356	0.063
New cases per week	−0.448	0.017
Follow-up cases per week	−0.356	0.063

Figure 1 The trend of the total positive COVID case counts in Detroit, Michigan during the period of this study as well as patient flow into Kresge during this time. The grey line shows the total COVID cases in Detroit during the study period. The blue line represents all visits to the clinic per week during the study period. The orange line represents the patient’s first visits during the study period. The yellow line represents all patients presenting for follow-up appointments.