The Many Logistics And Challenges Of Launching A COVID-19 Vaccination Site
The placement of neon green tape along a National Avenue sidewalk was a decisive move. The color, location and purpose were all carefully selected for queue control at a new vaccination site — a tip Victoriano Diaz picked up after nearly a year of ushering crowds through COVID-19 testing sites.
“Regular tape is going to get dirty — you're not going to see it on this pavement once people start standing on it,” said Diaz, associate director of patient engagement and special events at Family Health Centers of San Diego.
The vivid markings Diaz and his team of two mapped out will safely navigate up to 750 socially distanced daily visitors — 93 people an hour — through the community clinic’s parking lot. But, like the tape, countless other decisions must be made — and challenges navigated — before a syringe even pierces the first patient.
The careful execution of a successful site is critical to reaching the county’s goal to inoculate 1.8 million San Diegans by July. Public health officials say every shot counts amid the limited flow of vaccines, and community clinics like Family Health Centers are key to reaching underserved areas most affected by the coronavirus.
The duct tape-spotted Logan Heights parking lot that’ll host Family Health Center’s upcoming endeavor sits in a ZIP code with one of the highest COVID-19 case rates in the county. But it’s part of a larger area that data show has the lowest vaccination rate out of the six regions in the county.
The uncertainty around vaccine shipments can stall efforts to improve on this — the Logan Heights facility was set to open Tuesday but was pushed back due to inadequate vaccine supply. But the Biden Administration announced this week it will be prioritizing clinics like Family Health Centers to receive direct vaccine shipments in an effort to improve equity.
The job of Diaz’s team is to make sure patients flow through the new site without a hitch once supplies come through.
“There's all kinds of small, little idiosyncrasies that people aren't aware of that we need to plan for,” he said. “So, simple things like your vaccination card: Where is this vaccination card being given to the person and who's going to write it? And is it going to happen at registration? ... Are they going to get it in the vaccination area?”
The adhesive markers are designed to weave patients through a four-zone maze, stretching from the entrance at the lot’s front sidewalk and on through registration, a waiting area, the vaccination tents and then the observation zone before leading them out the alley exit. Diaz’s team must help plan for all the staff, stuff and procedures necessary at every turn.
They also have to calculate volunteers needed to register and guide patients through, ensure sidewalk space for early birds that arrive ahead of schedule and develop a system to track the 15-minute observation period for patients with various vaccination times.
“You would think 15-minute calculations are easy to do in your head, but when you're doing 20 people, a 15-minute calculation constantly is very difficult,” Diaz said.
Plus, they have to find a place to securely store all the chairs, tables, iPads and other supplies when not in use.
“Where are we going to stick it all when you're talking about 40 chairs? That's a lot of chairs that you need to account for,” Diaz said.
At the end of each 8-hour day, they’ll reflect on what lessons they learned.
“It's not just about creating vaccinations available for people, but what's their experience going through the process of getting vaccinations?” Diaz said.
They have to make sure every single daily patient returns in a few weeks for their second dose. Diaz said the site’s emphasis on patient experience is what he hopes will bring them back for round two.
No new launch date has been set as Family Health Centers awaits to hear when the Biden Administration's new program will reach them. They're hoping shipments will arrive the week after next.
Here is the breakdown of the Logan Heights vaccination site plan:
ENTRY: LINING UP
Patients will line up in one of two lines along either side of the gated entrance. One line will accommodate the current hour’s appointments while the other is for people scheduled the next hour but chose to arrive early. Proper distancing will be marked with neon tape. Patient engagement specialists will be interviewing and pre-screening patients for eligibility as well as answer concerns or questions about the vaccination.
ZONE 1: REGISTRATION
From the sidewalk, patients will be directed to one of four registration lines. Volunteers/staff will check-in patients, verify their eligibility and appointment, and use laptops to enter patient names into a digital queue.
“Based upon the time they get registered, they get put on to a queue and that queue is going to be able to allow us to know who's next in line. So, it's not something that's random,” Diaz said.
They’ll then be directed to a seating area in zone two.
ZONE 2: WAITING ROOM
The open air waiting room with a view of the Coronado Bay Bridge will hold about 20 socially distanced chairs. Diaz said the zone will help deal with any bottlenecking.
“We want them to have a seating area that they're going to wait in if we do have to take a little bit more time with other patients,” he said.
ZONE 3: VACCINATION
Staff/volunteers will use laptops to identify and call up the next name in the digital queue and direct patients to one of five vaccinators. Patients will receive a vaccination card from a volunteer assisting the vaccinator and then they’ll be directed to a volunteer handing out slips of paper with their exit time. Patients will be directed to a seated observation area where they will wait from 15 to 30 minutes depending on answers to medical questions asked during the pre-screening.
ZONE 4: OBSERVATION
Patients will sit in one of 20 socially distanced chairs while they complete their waiting period. Medical volunteers will monitor for signs of adverse reactions, including any patients experiencing anxiety. Observers will have an emergency line in case of a problem and staff in the tent are the facility’s urgent care clinicians.
During the waiting period, which will last 15 to 30 minutes, specialists will rove patient-to-patient and verify follow-up appointments. Patients will then show a slip of paper to a volunteer who will verify their exit time before directing them out through the alley.