Operationalizing care in a hospital-based respirology clinic during a global pandemic

Abstract

The novel coronavirus (SARS-CoV-2) pandemic has forced clinicians across Canada to abruptly adapt to a new reality of reduced contact with patients in ambulatory care settings. With minimal lead time, ambulatory clinics in Canada were required to adopt aggressive infection prevention and control measures while facing shortages of personal protective equipment and to enact strategies to urgently reorganize patient care. These adaptations included the conversion of ambulatory clinics to telephone or virtual care platforms. In 2015, the Public Health Agency of Canada (PHAC) published pandemic influenza preparedness guidelines highlighting the importance of pandemic preparedness planning in primary and ambulatory care settings, including clinic continuity planning and provisions for non in-person care. Despite these recommendations, hospital-based ambulatory clinics lacked formal strategic plans to adapt patient care processes during the SARS-CoV-2 outbreak. Thus, in a short time frame, clinics individually adapted their own patient care processes. This creates the potential for gaps in quality of medical care for patients across Canada. In this report, we describe the evolution and operationalization of care planning in our hospital-based respirology clinic, highlight the challenges faced, and make recommendations for respirology clinic adaptations based on available guidance. This process may be used as a foundation to guide future policy, discussion and guidelines for hospital-based respiratory care to ensure optimal preparedness during the next inevitable respiratory viral pandemic or possible worsening of the current pandemic.