The UCHealth team held its first Mass Vaccination trial at Coors Field on Sunday, 1/24. This was the first Mass Vaccine effort in Colorado, and was coordinated with the City and County of Denver, CDPHE (Colorado Department of Public Health and Environment), Denver Police, Verizon, Denver Health, Stadium Medical and the Governor’s Office. Weeks into planning, dozens of clinicians, staff and coordinators swarmed the location assembling, arranging, tweaking.
2 hours: 1,000 vaccines?
For this event, we planned to give 1,000 vaccines in 2 hours to stress-test our design plan and see if we could maintain or exceed this pace for future events. This was an invite-only event, with 500 patients selected from UCHealth’s pool of existing patients and 500 newly signed up from the UCHealth website for the general public (those aged 70-plus, per state guidelines).
Between 6 and 7 a.m., we assembled, got last-minute instructions for our many roles: runners, flaggers, registrars, traffic control, vaccinators, timers, process engineers, clinical observers, flow coordinators, etc.
The UCHealth team set up a small batch of cars to arrive between 8 and 9 a.m., to work out the kinks at every vaccine station. Each station received 2-4 cars to test our supplies and workflow, and see if the runners, pharmacists, flaggers, observers had any questions about their jobs.
We then huddled between 9-10 a.m. to debrief questions from the team, then BOOM. Our full-speed test was from 10 a.m. to 12 p.m., with 1,000 cars to come through in that time.
From the fourth floor of the Coors lot parking garage, the command center station. The RTD commuter trains run along the left, Blake Street on the right, the big white registration tent, where we catch and release any folks without appointment. The Mass Vaccine event (like every Covid vaccine clinic) is highly calibrated down to our last vaccine. If we accepted drop-ins or family members, we would run out of doses for our scheduled patients.
In the right row of tents, the first (most distant from us) tent is for registrations taking longer than usual, so that no registration line gets held up. Vaccine Tent 1 is thus the second (tiny) tent on the right. See me waving? No? No.
Our observation area (not shown) is actually behind the photographer, on the other side of the parking garage, with flaggers guiding the way.
Our work station setup. We re-arranged our area to be increasingly efficient. Working in teams of two allowed us to iteratively reduce our cycle time for each vaccination. Orange bucket 1: our vaccine supply (closely guarded by pharmacy and defrosted just-in-time). Orange bucket 2: pre-opened Band-Aids. Nothing is harder than cold, gloved hands opening Band-Aid packets when in a rush. Supply of gloves, alcohol swabs, gauze if needed. Raise the Yellow laminated card to indicate to runners if we needed supplies. Red card: help needed. Pink ribbon: attach to drivers side mirror for those warranting extended observation (e.g., previous history of anaphylaxis).
- One person waves down the car, says, ‘Please put it in Park!’ (about 1 in 3 don’t unless asked), asks the screening questions, and confirms which arm, which passenger.
- Simultaneously, second person (vaccinator) doffs/dons gloves, opens alcohol swab, snags a pre-peeled Band-Aid, and grabs a syringe.
- Pivot! First person files the screening paper with identity and signatures for later data entry and grabs the vaccine card.
- Simultaneously, vaccinator: Swab, Pre-attach 1/2 Band-Aid, vaccinate in one motion, auto-retract needle (more on this below), and swipe Band-Aid across. Done!
- Pivot! First person explains the card, answers any questions, reinforces importance of second appointment, and directs driver to proceed to next flagger to wait for the standard 15 minute observation time.
- Simultaneously, vaccinator disposes the syringe, clears trash, dons/doffs gloves and preps the next setup.
With this setup, Dr. Bajaj and I started with about a 90-second cycle time, and with iterative adjustments, pushed our best time down to 59 seconds, with our average running 1:15 to 1:20, if no questions (or profuse thankfulness) from the patients.
On debriefing this, we had several thoughts: the time it takes to chat and manage paper is about the same amount of time to swap gloves, manage supplies, setup. Seems like the 2-person team is, at present, an optimal setup.
In the coming weeks, it may be possible to incorporate a clinician-mobile-app adjunct to our EHR that would allow on-the-fly documentation and would take the place of paper questionnaires and signatures when in the field.
Paper is fast, but…
In terms of informatics, the paper process was a win from a through-put perspective, but an opportunity to streamline data-flow. We had runners taking our paper to the Documentation Tent to be keyed into the EHR in near-real-time.
Contrast that with our in-hospital based vaccine clinic (see my last post) where vaccination and documentation occur in real-time, the EHR and the State Vaccine Registry being updated almost immediately, and with a cycle time (with one vaccinator/documentor) at about 3 minutes.
At the end of our time, Vaccine Station 1 reported 67 vaccines given in 90 minutes. That is 80 seconds per shot. Taking into account the times when our station did not have a car, we think we could have completed 10 to 20 percent more shots. We are NOT Throwin’ Away OUR SHOT.
Here’s our high-level debrief. Team leaders from each of our major roles reported in: paramedics, police, City and County and State leaders, and the Rockies (thank you for the use of your massive parking lot and traffic expertise!). Very smooth. We think we can increase the pace beyond 1,000 per 2 hours. We are targeting 5,000 vaccines per day for 2 days.
There were zero anaphylaxis events. No paramedic transports. There were very infrequent side effects observed in the observation lots. Everyone drove away successfully.
CMIO’s take? Mass Vaccination: another chance to innovate, another chance to take a chunk out of the Covid pandemic. Send us more vaccines. We can handle it.
[This piece was originally published on The Undiscovered Country, a blog written by CT Lin, MD, CMIO at UCHealth and professor at University of Colorado School of Medicine. To follow him on Twitter, click here.]