Physician Outlook

COVID-19 S.O.A.P. Notes


Dr. Marlene Wüst-Smith is the medical director of a small private university health clinic when she isn’t publishing Physician Outlook magazine.

We recently put into action some of the actual instruments we borrowed from the “Trust Toolbox” to give her back some much needed time in her day.

COVID has complicated Dr. Wust-Smith’s normal workflow. Pre-pandemic, returning to campus for a new semester was relatively easy for Health Services—students showed up and were given their keys, and the only responsibility pre-return was making sure that students had submitted appropriate proof of vaccination. COVID has changed all that.

Health Services must now try to ensure that students are not inadvertently bringing that pesky little coronavirus along for the ride, and the rules seem to change by the moment. Every returning student must submit proof of a negative COVID test within a week of arrival, but not all test types count. If the student has had COVID, they MAY not need a negative test…if they can provide proof of a positive COVID test within the preceding 90 days. But not true if the student is from out-of-state…then they DO need to have another test. The rules and requirements seemingly change by the day, sometimes by the hour.

At a macro level, there is a risk to her university which has prided itself on retaining in-person learning at full capacity. Dorms are full, and athletes are practicing. For the purposes of this article, we will focus on the micro view which (only) impacts Dr. Marlene, her 4 staff, and the students.

“S” is for “Subjective”

This is the second semester of potential student isolation and quarantines, and the scope of this SOAP note is limited to communications. Because of the COVID outbreak which abruptly closed campuses across the world in the spring of 2020, when we returned in late August of 2020, the majority of Dr. Wust-Smith’s days were spent simply communicating new procedures to her staff and students. This took enormous amounts of time.  Due to the unknowns and recommendations changing by the day, these were not just conversations but often had the potential for confrontations because of the highly emotional and unknown aspects of the virus. There were conversations with students, staff and even parents.  In summary this time period was marked by long hours, even higher strain than normal, and difficulty maintaining morale.

Objective

To begin the process, Dr. Marlene was given a survey to measure how many repetitive conversations she had during this period, and how long each one took.

Review of the data demonstrated that each single conversation would take from 15 to 45 additional minutes on top of her normal work, which would then need to be charted and documented. This pushed her workday late into the evening.

“A” is for “Assessment”

According to this basic diagnostic, this novel virus created a significant level of chaos within the institution. However this chaos was mitigated by a fairly low number of repeat conversations that communicated new protocols. Ultimately the chaos was controlled, but not without enormous time, energy, and relational strain.

“P” is for “Plan of Treatment” 

For this reason, I helped to develop a mechanism to isolate, record, and deploy segments of those conversations.  Our goals were 2 fold:

1. Protect the proactive time of the physician and staff.

2. Offload the emotional strain by steering students to the audio feed:

  • manage expectations
  • provide basic info
  • be available to review when students forgot

This basic mechanism is in the form of an RSS feed, otherwise known as a podcast feed. Instead of the format of a podcast, we are focusing on delivering short minute long target answers to specific questions as well as short policies and action steps for the students and parents to know beforehand.

Employment of time-saving tools became an essential component of the University’s crisis management plan

Whether or not you practice in an educational setting, can you relate to this scenario - especially as it pertains to COVID?  Stay tuned to Physician Outlook to follow this and future case studies.

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