COVID vaccine rollout: What GPs can learn from one doctor’s trial run

Anastasia Tsirtsakis

4/03/2021 4:17:38 PM

As the nationwide rollout of AstraZeneca approaches, GP Dr Mukesh Haikerwal reveals the logistical realities exposed during a three-hour run through at his clinic.

Dr Mukesh Haikerwal and staff.
Dr Mukesh Haikerwal and his practice staff during their practice run through of the vaccination trial. (Image: Supplied)

The patient has given their consent to receive the coronavirus vaccine, and an appointment has been booked.
The day has arrived, and the patient is waiting in their car – what now?
That is what Melbourne GP and practice owner Dr Mukesh Haikerwal, responsible for setting up Victoria’s first GP-led respiratory clinic, set out to discover on Saturday.
With the help of his practice team, he oversaw a three-hour practice trial run of the vaccine rollout at his clinic in Melbourne’s west from start to finish – an experience he told newsGP was ‘quite intense’.
‘There are so many things to do in a relatively short length of time for a large number of people with surety in a continuing way,’ he said.
Dr Haikerwal’s practice team is aiming to vaccinate six people every 15 minutes – that’s 24 an hour, or 240 over the course of 10 hours – with room to expand as the weeks progress.
‘Twenty-four an hour – it’s quite a logistical feat to manage that,’ he said.
‘If we manage to increase it to 30 a quarter, you get 120 an hour. So potentially you can get 1000 or 1200 in a day.
‘It’s not an awful lot when you’re looking at 20–25 million people. But we’ve got to get through … that’s why you need a more concerted effort. We decided as we head towards larger numbers, let’s start small.’
The trial saw patients arriving to an allocated carpark wearing a surgical mask. Approaching the clinic, a health assistant awaits to accompany them to a check-in desk where their identity is confirmed, consent is reaffirmed, temperature is taken, and routine questions are asked about any cold and flu symptoms, and general health.
Dr Haikerwal stresses that the patient must arrive neither early nor late for their appointment.
‘If they’re too early, you say, “Please go back to the carpark and come back at your proper time”,’ he said.
‘We haven’t got enough room to [deal] with you and the people who should be here.’
Once that process is complete, patients are accompanied by a health assistant through to the clinic where they are each allocated a separate room.
‘[We] get them to put their stuff on the chair, roll up their sleeve, explain who’s coming in and confirm who they are,’ Dr Haikerwal said.
‘The nurse comes in with the vaccine, again reaffirms their five-point check, checks they understand what’s going on again, does the vaccination, and then they are taken to a waiting area [for observation].
‘The room has been cleared already by the health assistants taking the patients to a waiting area, and the next wave is ready to come in.’
If no side effects are detected after the patient has been observed for 15 minutes, they are then escorted by a health assistant to their car.
Two nurses are on duty to vaccinate three people, and by the time a nurse gets to the third patient, the next lot of vaccine doses are already being prepared.
‘The nurse returns to the preparation area where individual doses of the vaccine are being prepared, while other people are arriving,’ Dr Haikerwal said.
‘So, they can literally go into the room, do the vaccine, go back and pick up another vaccine.’
Consistency is key to the effort, and that also goes for infection control. As people move from room to room, and each new wave of patients comes through, an assistant cleans down each chair.

Patients waiting out the front of the clinic during the mock run through of the COVID vaccine rollout. (Image: Supplied)
‘You actually need two or three chairs – one that you’ve sat on, one that you’ve sprayed, and one that has been sprayed and has dried so that you’ve got a continuous supply of chairs to make sure that you’re not waiting for the chairs to dry,’ Dr Haikerwal said.
To make the process as easy as possible, the practice team also plans to give each patient a business card on arrival with the date, time and vaccine they will be receiving on the day.
‘We thought we’d give them the business card as they left,’ Dr Haikerwal said.
‘But it makes much more sense to do that on the way in so that they carry it with them. [That way] you can show it to the vaccinator, then to the person watching in the observation room, and the person that is going to take you back to your car, so you don’t have to keep identifying yourself.’
The Therapeutic Goods Administration has recommended a 12-week waiting period between each dose of the Oxford University/AstraZeneca vaccine, a timeframe that adds to the challenge of ensuring a patient rebooks on time.
‘You can guarantee your bottom dollar 40–60% of people will default from that appointment in 12 weeks’ time,’ Dr Haikerwal said.
‘If you’ve got a system that can send them a text a month before they’re due to say, “Make your appointment now, either online or call us”.
‘Then the second run through is easier because they’ve done it once.’
Based on the logistical realities, Dr Haikerwal says it would be best to run after-hour clinics.
‘You wouldn’t work it in normal working hours because the car parks are being used by other people,’ he explained.
‘You’d use it in the afternoon and evening when people are starting to leave the site so you can use a carpark more efficiently.’
Meanwhile, when it comes to staffing, even though Dr Haikerwal is able to draw from respiratory clinic resources, he has not been able to avoid recruiting additional staff altogether.
‘We are having to now reach out to health faculties at universities, for instance science faculties, [for] people who would benefit from having that kind of clinic exposure,’ Dr Haikerwal said.
‘We’re recruiting and training them in-house … and making sure they’re across all of the COVID-safe infection control principles, basically so they’re in a position to do this safely; safely for themselves and safely for the patients.’
The mass vaccination program has often been described as a ‘wartime effort’, and Dr Haikerwal and his team experienced this firsthand during the trial run.
He says practices first need to ensure there is a seamless booking process and that consent has been finalised ahead of their vaccination, and that appropriate educational resources are supplied if needed. Employing online reception staff to assist with the process is also helpful, according to Dr Haikerwal, who implemented the idea for his respiratory clinic’s booking system.
‘It has made it much easier and we’ve got more people who weren’t carrying iPhones, who weren’t having English as their first language, and who were particularly elderly, now able to come. Whereas before they weren’t,’ he said.
‘It’s important that we actually make it equitable as well as accessible.
‘Consent will be taken in our set up by the nurse taking online consent, which will be reaffirmed face-to-face when people actually go into the clinic itself.’
Would he recommend other practices undertake their own practice run?
‘Definitely,’ he said.
‘Either observe somebody else’s and then learn from that, or certainly do your own so that you know what you’re doing because proof of the pudding is in the tasting.
‘It’s only when you’ve had a go that you know where the difficulties come up. It’s not a flu vaccine – it’s a lot more complicated.’
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Dr Jane Elizabeth Opie   5/03/2021 12:41:43 PM

Thanks again Dr. Haikerwal for your insights.
Doing a "dry run" in-house makes a lot of sense.
Logistics such as car-parking availability are key alongside the challenges of continuing to provide quality general practice care for all patients; and in a few situations, continuing to work as a respiratory clinic. This will be a challenge for Australian General Practice but we have a proven record of delivery of quality care efficiently and effectively - whether or not we've been adequately financially reimbursed via Medicare.

Dr Christopher Mark Jones   6/03/2021 6:55:48 PM

Insightful, but expensive and unnecessary stages for most General Practices:
: patients and staff wearing masks
: patients being escorted or various rooms and eventually their cars
: vaccine chairs being sprayed down between patients
All of this adds to extra staff, time and costs , which all have to be taken into account. I would also question the degree of PPE/cleaning being carried out

Dr Roberto Celada   7/03/2021 10:47:35 AM

We are currently doing normal consultations without spraying chairs etc. why do we need to spray for vaccinating normal regular patients?

Dr Richard Harper   14/03/2021 10:39:15 AM

Hints from the UK (after 10000+ jabs)
1. book 1st and 2nd appointments exactly same time 12 weeks apart (= no gaps)
2. insist on time 5 mins before appt to complete consent, bring own pen
3. ideally someone else drives
4. one way system: use fire exit?
5. volunteers greet & give wipeable clipboard with consent/risk form
4. 3 minute appts (?2) + breaks
5. 2 chairs inside doorway, wipe them
6. vials give 1 extra dose, 2, or 0, depends on batch - backup list for spares
7. volunteer gives record card, advice sheet, observes if risk
8. capacity to deal with reaction without flow stopping