Successful implementation of a drive-through influenza vaccination clinic
The current COVID-19 pandemic presents a unique challenge to the administration of influenza vaccines in the clinic setting. The risks of elective clinic visits and congregating indoors are increased due to the novel virus. Drive-through clinics are a safe and effective way to increase vaccination rates and safety. Patients remain in their vehicles for their vaccination appointment, and staff members administer vaccines from an entirely outdoor clinic.
The drive-through approach is preferable over a standard clinic for a multitude reasons. It reduces cross-infection risks within clinics by keeping patients separated and masked - each participant’s vehicle acts as an isolation chamber. Many more vaccines can be administered with the same amount of time and resources. Lastly, it is good for patient privacy and reduces appointment time for patients.
Drive-through clinics have been previously modelled as a way to vaccinate in emergency events, maximizing vaccination rates while ensuring the safety of patients and staff1,2. However, their performance in the context of an unfolding pandemic has yet to be described. This article describes the implementation of drive-through influenza vaccination clinic in rural Ontario, comparing patient volume between the 2020 drive-through clinic and 2019 standard vaccination clinics at the same location. It was hypothesized that vaccine clinic throughput would increase using a drive-through model.
The drive-through clinic model described here administered influenza vaccines outdoors at a family health office, with patients parking in vacant spots. Drive-through clinics were run for a total of six weeks between September and November, 2020. Each clinic day lasted from 9:30 am to 1:00pm.
Patients called in advance and were given an appointment time. During the appointment call, patients were also pre-screened, determining if they had received the influenza vaccine before and if there was a previous adverse reaction. If it was their first time getting the influenza vaccine, or they had a previous adverse reaction, patients were excluded from the drive-through clinic and vaccinated in office so they could be monitored more closely. Patients were told to wear a mask for COVID-19 safety, and a t-shirt for ease of vaccine administration.
Drive-through clinics were scheduled on days where only one physician was seeing regular patients, to ensure less regular traffic to the clinic and adequate parking for vaccine recipients.
Nursing staff pre-drew the vaccines, and set up an outdoor table with the vaccines, sharps container, gauze, bandages, and alcohol swabs. The clinic itself is on a low-traffic side street, with an open-air parking lot. The vaccine was stored in a temperature-controlled cooler.
As patients arrived, they would drive up to the nursing table outside, and were told to park and wait for the nurse. Patients were checked in by a medical office assistant who would ensure the patient was on the list to be vaccinated, would input the lot number of the vaccine into the patient’s record and would bill the visit through our Electronic Medical Record. A Registered Practical Nurse then administered vaccines to patients through their car windows, often multiple patients per vehicle. Patients were told to remain parked in their vehicles for fifteen minutes, and honk if they needed help.
Over a total of 6 half day clinics, 581 patients were vaccinated, for an average of 97 patients per half-day. In previous years our vaccination clinics have averaged around 30 patients per half day. There were no adverse events.
This increase in efficiency was due to four main reasons. First, pre-screening was done on the phone rather than on check-in. Second, the appointment time itself was reduced, with patients already in t-shirts, rather than having to take off coats and sweaters. Third, patients attending the drive-through clinic rarely showed up at the same time, and if they did, there was no line up – all patients were parked and then vaccinated simultaneously by different nurses. Fourth, we were not limited by the physical space inside of the clinic and waiting room as our parking lot and surrounding area can accommodate many more patients, particularly if there are multiple patients per car.
Although first implemented as a COVID-19 safety measure, the family health team intends to continue drive-through clinics for the influenza vaccine indefinitely. Historically the influenza vaccine has seen low rates of uptake among the Canadian population3. It is likely that offering drive-through clinics will increase vaccination rates, while keeping costs and health risks low.
This model may be worth considering to expedite the delivery of COVID-19 vaccines as well although it should be noted that we pre-screened patients for reactions to the flu vaccine and they were excluded from drive through clinics if they screened positive. Careful consideration of this limitation should be done if this model were to be adapted for COVID-19 vaccination.
Christie McLaren, Queen's University School of Medicine, Kingston Health Sciences Center
Dr. James Simpson, University of Ottawa School of Medicine, Queen's University School of Medicine
Trish Fielding, Elliot Street Clinic
Dr. James Simpson and Trish Fielding designed, directed, and implemented the clinics. Christie McLaren and Dr. Simpson contributed to the analysis of the results and writing of the manuscript. All authors revised the work for intellectual content and provided final approval of this version.
References
1. Weiss EA, Ngo J, Gilbert GH, Quinn JV. Drive-through medicine: a novel proposal for rapid evaluation of patients during an influenza pandemic. Ann Emerg Med. 2010 Mar 1;55(3):268-73.
2. Buck BH, Cowan L, Smith L, Duncan E, Bazemore J, Schwind JS. Effective practices and recommendations for drive-through clinic points of dispensing: a systematic review. Disaster Med Public Health Prep. 2020 Apr 1:1-5.
3. Statistics Canada. Vaccine uptake in Canadian Adults 2019 [Internet]. canada.ca. 2019 [cited 2020 Nov 17]. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/2018-2019-influenza-flu-vaccine-coverage-survey-results.html