Designing Safe Care in a Drive-through Setting

Executive Summary

The COVID-19 pandemic has increased the reliance on drive-through models for limited medical services. Drive-through programs require time and consideration to prevent risk to patients and staff while mitigating liability. 

Recommended Actions 

• Utilize the CDC guidelines and checklist to ensure safety and effectiveness of drive-through locations.
• Follow practice standards for quality of care, preventing virus transmission and adequate staffing.
• Design a safe work environment for staff with appropriate lighting, security and signage.

The COVID-19 pandemic has caused unprecedented changes to our daily life and altered the way in which many services are delivered, including healthcare. While the use of a drive-through model for limited medical services has existed for some time, it has increased exponentially in testing for COVID-19. As healthcare organizations and patients continue to look for additional ways to reduce human-to-human contact and mitigate virus transmission, we anticipate drive-through clinics will be a popular mode for providing vaccinations (routine, seasonal and the COVID-19 vaccinations).

Time and careful consideration should be taken when designing and implementing drive-through programs. Regardless of the type of medical service provided in a drive-through setting (e.g., vaccinations, testing and treatment for chronic conditions such as diabetes or common illnesses like the flu), addressing key items in the design phase, as well as the constants that must remain, will prevent risk to patients and staff and mitigate liability:

Planning: Strong planning is important to mitigate risks with drive-through medical care. For purposes of assisting healthcare organizations and providers in establishing vaccination clinics, the CDC has provided an in-depth, easy-to-follow tool for satellite and drive-through vaccination clinics, Guidance for Planning Vaccination Clinics Held at Satellite, Temporary, or Off-Site Locations.

A checklist is available to assist in compliance with the CDC guidelines and best practice recommendations. Following these guidelines will help ensure safety for all participants and vaccine effectiveness. (See Influenza Work Group of the National Adult and Influenza Immunization Summit.) Although the checklist is specific to vaccination clinics, the same principles apply to other medical services provided in a drive-through setting. 

Staffing: Ensure that you have an adequate amount of appropriately licensed and trained staff working within their scope. State guidelines must be followed as it relates to licensure, supervision and scope. Staff must also be adequately trained and deemed competent to provide such care.

Practice standards: It is expected that the applicable standard of care will be met regardless of the location of care. Adherence to generally accepted practice patterns will arguably satisfy that standard, while also providing the same quality care in a drive-through setting as the patient would receive in the practice and minimizing risk exposure.

Infection control: Policies, protocols and processes for safe practices must continue to be followed to reduce the risk of infection in patients and staff. Appropriate personal protective equipment (PPE) must be available and utilized in accordance with infection control practice guidelines. When applicable to the care provided, protocols and processes for safe needle use and disposal should continue to be followed.

Screening for contraindications/adverse reactions: Allow ample time and have the necessary equipment to appropriately screen patients and monitor for adverse reactions. For example, the Advisory Committee on Immunization Practices (ACIP) published guidelines for immunization recommend observing patients for 15 minutes after vaccination due to the risk of syncope. This recommendation is of significance for a drive-through vaccination clinic given the potential for injury, especially when the vaccinated person is the driver.

Educational information: Develop and distribute educational materials to your patients ahead of time to help mitigate the general safety risks associated with the provision of care in a drive-through setting, such as motor vehicle incidents. 

Given that drive-through care may be a new experience for many people, educational materials may include the following topics to help patients prepare: whether an appointment is needed, what to bring (such as photo ID and insurance card), cost of the services not covered by insurance, any paperwork that may be filled out ahead of time, type of services/vaccinations available (regular-dose flu shot, nasal spray vaccine, different flu shots for young children and adults 65 and older), what to wear (short sleeves or loose clothing), recommendation to have another adult accompany the patient to the drive-through clinic, and, of course, the importance of wearing a face mask.

In addition to written materials, some organizations have put together videos to further prepare patients for the drive-through care experience.

Environmental safety & security: Ensure that any hazards that cannot be removed are clearly marked. Design signage and barriers to create a protective area for staff to work. Also be certain to have appropriate lighting, security and protection from the elements when applicable.

Emergency response: Have emergency procedures in place and provide training to staff on steps they should take in case of an emergency. Prepare for an emergency and have appropriate equipment and medication immediately available in case it is needed.

Regulatory compliance: Ensure that your processes and care are provided in compliance with federal, state and local laws and ordinances, such as:

• HIPAA Privacy and Security
• OSHA
• Americans with Disabilities Act
• COVID-19 guidelines

For organizations interested in providing the COVID-19 vaccinations in either a drive-through setting or in the practice, the CDC has published information to assist healthcare providers preparing to administer a COVID-19 vaccine, including web-based training outlining best practices and principles, clinical material for each vaccine and resources for engaging patients in the conversation about the vaccine with suggested responses to anticipated questions. Adherence to these recommendations will be critical to the success of a vaccination program.

Additional Resources:

• Advisory Committee on Immunization Practices (ACIP) – General Best Practice Guidelines for Immunization (Updated November 2020)  
• Specific Resources for COVID-19 Vaccination Clinics
• CDC – Healthcare Professionals: Preparing for COVID-19 Vaccination
• Institute for Safe Medication Practices – An ECRI Affiliate. Medication Safety Alert! November 19, 2020.  Volume 25, Issue 23.

Lessons Learned 

• Provide appropriate patient screening before treatment and monitor for adverse reactions to services after treatment.
• Prepare for an emergency by having appropriate equipment available and training staff on necessary steps they should take.
• that your drive-through method complies with all up-to-date state and federal regulatory law. 

Potential Damages

Healthcare organizations that improperly manage their temporary patient clinics or drive-through patient service settings could face a variety of issues ranging from medical malpractice to administrative investigations. Although the number of such violations is relatively low, this low frequency could reflect the fact that drive-through medical care has only been utilized for a short period of time. Additionally, the severity of such claims can quickly add up, especially if the healthcare organization has to defend against a costly lawsuit.