The emergence of the COVID-19 pandemic in early 2020 caused medical institutions across the world to examine how they could continue to safely deliver ambulatory and preventative health services. The first case of confirmed SARS CoV-2 virus in Minnesota was March 6, 2020, and on March 19, 2020, Governor Walz issued Executive Order 20-09 “Directing Delay of Inpatient and Outpatient Elective Surgery and Procedural Cases during COVID-19 Peacetime Emergency.” In a very short time frame, medical institutions across Minnesota were challenged to quickly develop innovative avenues to provide safe care during this unprecedented time. The American Academy of Pediatrics developed guidance for pediatricians regarding the delivery of well-child care during the COVID-19 pandemic. Recommendations included prioritizing in-person newborn care, well-visits and immunizations for infants and children through 24 months of age.
At Mayo Clinic, primary care leadership quickly created separate locations of care delivery based on age, appointment type (acute ambulatory vs preventative maintenance), symptoms, and risk factors. One of the clinics that was developed was the NEwborn and Antenatal Testing (NEAT) Clinic whose primary goal was to create a safe way to deliver routine, preventive services for newborns (<2 months of age), as well as antenatal testing for high risk pregnancies. A multidisciplinary team was assembled and implemented this clinic in four business days. The NEAT Clinic saw patients from March 31, 2020, through May 29, 2020, using the AAP guidelines for safety and timing.
This clinic was located at Mayo Clinic Northeast Family Clinic in Rochester, a satellite primary care clinic outside the downtown campus. It was staffed by a multidisciplinary team from the Departments of Community Pediatric and Adolescent Medicine, Family Medicine, Obstetrics and Gynecology, Nursing, Radiology, and Laboratory Medicine. Newborn appointments for all primary care in the Rochester and Kasson area were moved to this location and occurred from 8 a.m. to 10 a.m. All other patient appointments that would be typically seen at this location were converted to virtual visits, moved to a different primary care location, or seen later in the day. No other patients were allowed in the building until newborn and antenatal appointments were completed. Strict infection control measures as well as rigorous patient symptom screening protocols were used.
Both provider (physicians and advanced practice providers) and R.N. visits were offered and services included hospital and ER follow-ups, acute visits not related to illness symptoms, lactation support, growth checks, and laboratory monitoring. The NEAT Clinic was kept in the same hallway and rooms unless demand required otherwise. Phlebotomists came directly to patient rooms for blood draws to avoid unnecessary exposures throughout the clinic. There was an identified pool of providers to staff the clinic who were divided into cohorts rotating on and off on a weekly basis to minimize cross-contamination of potential unknown positive cases. Communication amongst staff was optimized by using twice daily huddles following social distancing guidelines.
In late May of 2020, the NEAT Clinic was deactivated as the rest of the practice was brought back online. The NEAT Clinic was widely viewed as a success, allowing the continued delivery of important health care in a safe manner, while buying time as health care practices, governmental agencies, and medical societies furthered their understanding of and readiness for this still perplexing disease. As patients returned to their traditional locations for health care delivery, they were met with new best practices and enhanced infection control measures, some of which were based on lessons learned from the NEAT Clinic, and some others of which were possible to implement because of the time that the NEAT Clinic bought for the practice. Patient feedback was overwhelmingly positive about the option to continue to receive care in what was perceived as a very safe environment.