Thoughts on Design Improvements for COVID-19 Mass Vaccination Sites for Vulnerable Communities

Engineers often must think about the social aspects of the problems they are solving, and a mass vaccination site is a great example of a problem that combines process engineering, medicine, and social science. I volunteered at one such site in a low-income area last weekend as part of a program to support pop-up clinics in vulnerable communities, and although my individual responsibilities were rather simple (welcoming guests, handing out vaccination cards, and cleaning seats), I couldn’t help but think that there were improvements to the design of the clinic that could make the process more efficient and comfortable for the patients.

Many patients come from vulnerable communities who don’t regularly interact with the healthcare system, and some design improvements could better accommodate the familial support which many of these patients rely on in anxious circumstances. Furthermore, although the United States is well on its way to vaccinating much of its population, many other countries still have a long way to go, and I believe that a spirit of design thinking could both improve throughput in these facilities and reduce vaccine hesitancy.

Translation/interpretation for non-English speakers represents a critical constraint and efficiency could be improved with a more patient-centric usher model

Most non-English speakers showed up at the clinic with younger English-speaking family members who were also patients. This slowed the process because the family member serving as an interpreter had to wait for their other family members to be vaccinated before they themselves could get their shot. This also caused our patients anxiety because many didn’t know what was going on – and if their other family member was preoccupied with their own vaccination and couldn’t interpret, they couldn’t get answers right away. Our clinic had consent forms available in several different languages with interpreters available to help, but those resources were not always available during the later steps of the process.

I think this process could be improved with a more patient-centric usher model. If families were met by a trained volunteer who accompanied them from intake through discharge, the process would operate more smoothly and quickly, and the vaccination process would be decoupled from the critical rapport-building, anxiety-reducing process where patients are asking questions. Community members who haven’t had as much exposure to the healthcare system are certainly going to be more anxious about the process than patients who are familiar with healthcare settings, and a friendly face may be exactly what’s needed to make the process more effective and comfortable for everyone.

Identification of critical paths and required resources for vaccination process could improve throughput and reduce nurse time per patient

The entire patient journey requires quite a lot of unique steps, and a detailed identification of those steps and required resources can help improve throughput and reduce waiting times. Consider the vaccination step – where the nurse actually injects the patient with the medication. This process consists of multiple steps, including:

  • Initial introduction to patient and rapport building while moving to patient location and putting on new gloves (~30 sec)
  • Asking patient which arm they want to receive the shot, and explaining that they (the nurse) don’t have a preference (~15 sec)
  • Helping patient roll up sleeves or otherwise expose arm to get vaccinated (~5 sec)
  • Opening bandage and setting aside so it can be applied to patient when ready (~5 sec)
  • Opening alcohol pad and wiping arm (~5 sec)
  • Helping the patient relax their arm, injecting the medicine, throwing away the syringe, and applying the bandage (~10 sec)
  • Instructing the patient about the rest of the process, informing them they have to wait for 15 minutes, and answering further questions (~30 sec)

By my estimates, it takes a nurse approximately 100 seconds to vaccinate a patient from beginning to end, but many of these steps (especially regarding the introductions, rapport building, and followup instructions at the end) could be performed by other people under a more patient-centric model, thus reducing nurse time per patient and improving the number of vaccinations that each individual nurse can provide in a given time period. Nurses at our facility also had to manage their own inventories of vaccines and PPE, which caused delays when nurses had to pause vaccination to obtain more equipment.

Speed up vaccine thawing and preparation process

Another critical path is the vaccine thawing and preparation process. This part of the process was not visible to me so I can’t comment on the details, but both at our clinic and at a different site in San Francisco (where I was accompanying a family member for their appointment), the long lead time required to remove a vaccine from storage, thaw it, and prepare the syringe caused extra wait times as volunteers had to count and manage the people in line to ensure no vaccines were wasted. If vaccines could be thawed more quickly from deep-freeze storage, they could be thawed on a just-in-time basis and given to patients immediately as new allocations arrive, thus improving the patient experience and reducing administrative burden.

Improve the waiting experience for patients under supervision

Patients who receive a COVID vaccine are generally required to wait 15 minutes under supervision to check for adverse effects of the vaccine – and those with a confirmed history of allergies or other risk factors have to wait even longer. This caused problems for many of our patients, who were forced to sit silently in socially-distanced chairs after receiving a new vaccine. We were forced to separate parents from their children, and families often couldn’t sit together too. Although this makes sense from a strictly public-health perspective, some flexibility should be given to better accommodate those patients who are nervous about the process and who are accompanied by loved ones.

These are just some examples of design improvements that could be implemented quickly for vaccination sites for vulnerable communities – further observation will certainly uncover more. I hope that this sparks some ideas among the wider medical and engineering communities and results in more efficient and effective vaccination efforts.

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