Rapid Implementation of a Vaccination Superstation (USA)

Series: Lessons learned from vaccines roll out

JAMA NETWORK, January 28, 2021
Christopher A. Longhurst, MD, MS1,2; Brendan Kremer, MHA1; Patricia S. Maysent, MBA, MHA1

On January 6, 2021, a short call between key leaders at UC San Diego Health and the San Diego County public health services resulted in a conceptual agreement to open a coronavirus disease 2019 (COVID-19) vaccine superstation with a target of vaccinating 5000 health care workers daily. The teams were challenged by leadership, without constraints, to imagine, develop, and implement this concept with an urgency borne from the region’s deep need to administer COVID-19 vaccines to the local community after UC San Diego Health had already vaccinated more than 10 000 of its own health care workers over a 4-week period.

Five days later on January 11, the teams opened the first large-scale vaccination site in California, and 2 weeks later more than 58 000 community members have been vaccinated.1

This Viewpoint describes lessons learned in this rapid implementation with the hope this experience will catalyze similar centers across the country at a time when COVID-19 has become a leading cause of death in some age groups.2

Leadership and Partnership among Academy & Healthcare (UC San Diego Health), and Local County (San Diego County Public Health Services)

On January 6, 2021, a short call between key leaders at UC San Diego Health and the San Diego County public health services resulted in a conceptual agreement to open a coronavirus disease 2019 (COVID-19) vaccine superstation with a target of vaccinating 5000 health care workers daily.

Aligned partner & location (San Diego Padres)

The first key decision for the new collaboration was to identify an aligned partner and location large enough to handle 5000 vaccinations daily. UC San Diego Health had an existing relationship with the community-minded San Diego Padres, who were looking for ways to support the region through the pandemic. A call to the Padres leadership resulted in access to a location, and the event support services needed to establish the vaccination superstation. The San Diego Padre parking lots adjacent to Petco Park offered a large size (280 000 square feet) in an outdoor location that is centrally accessible to both personal and public transportation. In addition, the site provided controlled access during the day and ability to be secured overnight. The city police were familiar with traffic flows associated with large events and the venue was close enough to the health system for distribution of vaccines and supplies. This 3-way partnership allowed each member to bring strengths that enabled opening the new super site in just 5 days.

Counting funding, vaccine supplies and city authorities coordination

San Diego County provided vaccine supply and funding, along with essential contacts for police, fire marshal, and traffic control.

Operational logistics model and staffing for vaccine administration + Event Planning Experience

UC San Diego Health brought a model for operational logistics learned through on-site employee vaccination, and supplied the majority of the staffing for vaccine administration.

The Padres provided the land and extensive event planning experience, including expertise in hosting drive-through activities during the COVID-19 pandemic. It would have been much more difficult to open the center in the short time without the Padres turnkey contracts for access to tents, trailers, signage, fencing, and restrooms.
The Padres also provided contract access to security and parking vendors to manage on-site flow, and San Diego County arranged for traffic flow outside of the site.

Requirements:

1. IT INFRASTRUCTURE

A critical component of any vaccine superstation is IT (information technology) infrastructure.

• Within 3 days of the decision to open, the UC San Diego Health team posted a website to allow health care workers to begin scheduling appointment times for vaccination.
• This self-scheduling functionality was integrated in the enterprise electronic health record (EHR) and helped to ensure that the process also served to preregister health care workers who had not previously been seen as patients at UC San Diego Health.3
• In parallel, the technology team installed 5000 feet of power cable and deployed 85 laptop computers on wheels.
• The San Diego Padres provided wireless internet for the entire parking lot.
• Since the EHR was already integrated with the state immunization registry, all administered vaccine doses would be visible to other sites around the county to assist second-dose logistics.4

2. STAFFING PLAN

Another integral part of the project was the staffing plan.

• The initial delivery model required more than 300 personnel each day, approximately 120 in clinical and 180 in administrative roles.
• An “all hands on deck” request was sent by the health system chief executive officer to all UC San Diego health personnel with an electronic survey to identify staff and supervisors who could redirect their own shifts to the superstation site while not jeopardizing the critical staffing required to handle the ongoing COVID-19 inpatient surge at the hospital.
• The established float pool process from the emergency preparedness program was implemented to oversee the staffing model, and a web page was developed to engage community members who wanted to volunteer.
• Using existing volunteer and labor pool systems and processes ensured effective staffing of the superstation, although the ratio of paid and volunteer staff for the site continues to be refined.
• An unanticipated benefit of the superstation is that it has served to energize some personnel who are COVID-19 weary, allowing staff members to contribute in a positive and meaningful way to ending the pandemic.

3. WORKFLOW DESIGN

The project management and process optimization teams engineered and optimized workflow (eFigure in the Supplement).5

• All vaccination is done by appointment only, scheduled online via the EHR.
• Vaccines are stored at the nearby hospital and brought to the park to thaw as needed. Individuals with scheduled visits enter on the north side of the parking lot where they are routed to a registration tent for confirmation of vaccine eligibility and registration data.
• After this is completed, 12 vehicles are brought into a single row of 3 tents (4 vehicles per tent), where vaccines are administered to all 12 individuals in their vehicles by 3 vaccinators (1 per tent).
• A 15-minute countdown timer for adverse event monitoring starts when the person in the last of the 12 cars is vaccinated, and the 3 vaccinators then switch to the opposite tent to vaccinate another 4 cars each.
• A separate area is set aside for 30-minute monitoring of any patients with prior history of vaccination reactions.
• Each row of 12 cars moves together. The theoretical maximum is 4 vehicles/tent × 3 tents/row × 12 rows × 3 turns/hour (20 minutes) = 432 doses per hour, or 5184 doses in a 12-hour day. By day 14, this approach had reached more than 5400 vaccine doses administered per day, and further optimizations are planned as this site is expected to continue operation for several more months.

4. EHR ACESS AND TRAINING

As part of process optimization, it was clear that documentation in the EHR could be a limiting factor. Since provisioning EHR access and training is also a barrier for external volunteers, a scribe workflow was developed, allowing both faster vaccine turnover and easier onboarding for community volunteers who might be retired physicians, pharmacists, nurses, paramedics, and others licensed to administer intramuscular injections, while previously trained hospital personnel handle documentation.

Establishing infrastructure like this in such a rapid time is unfamiliar to most health systems. The cooperation between UC San Diego Health and the Padres, and the use of a single EHR made this easier.

Lessons from this experience could be helpful for other academic health institutions or community health centers that consider partnering with their neighboring sports or entertainment venues to deliver as many vaccination doses as possible, to health care workers and to the public.

Corresponding Author: Christopher A. Longhurst, MD, MS, University of California San Diego, 9560 Towne Center Dr, Ste 100, La Jolla, CA 92121 (clonghurst@health.ucsd.edu).

Published Online: January 28, 2021. doi:10.1001/jama.2021.0801

Conflict of Interest Disclosures: Dr Longhurst reported receiving personal fees from Doximity, unrelated to this work. No other disclosures were reported.

Additional Contributions: We thank the entire UC San Diego Health superstation team including Shira Abeles, MD, Lydia Ikeda, Will Ford, Marlene Millen, MD, and Francesca Torriani, MD. We also thank Erik Greupner and the San Diego Padres, Nick Macchione and Wilma Wooten, MD, from San Diego County Health and Human Services, County Supervisor Nathan Fletcher, and San Diego City Mayor Todd Gloria. Finally, we thank Atul Butte, MD, PhD, and Carrie Byington, MD, of University of California Office of the President.

References

1.Sisson P , Wosen J . First day of mega vaccine clinic delivers thousands of doses. San Diego Union Tribune. January 11, 2021. Accessed January 16, 2021. https://www.sandiegouniontribune.com/news/health/story/2021-01-11/covid

2.Woolf SH , Chapman DA , Lee JH . COVID-19 as the leading cause of death in the United States. JAMA. 2021;325(2):123–124. doi:10.1001/jama.2020.24865
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3.Reeves JJ , Hollandsworth HM , Torriani FJ , et al. Rapid response to COVID-19: health informatics support for outbreak management in an academic health system. J Am Med Inform Assoc. 2020;27(6):853–859. doi:10.1093/jamia/ocaa037 PubMedGoogle ScholarCrossref

4.Stevens LA , Palma JP , Pandher KK , Longhurst CA . Immunization registries in the EMR era. Online J Public Health Inform. 2013;5(2):211. doi:10.5210/ojphi.v5i2.4696 PubMedGoogle ScholarCrossref

5.Albanese CT , Aaby DR , Plathchek TS . Advanced Lean in Healthcare. CreateSpace Independent Publishing Platform; 2014.

Initially published at JAMA Network

Published Online: January 28, 2021. doi:10.1001/jama.2021.0801

Edited for Brazil by

Joaquim Cardoso do Rosário
Founder of the “Health for All Foundation”