McLeod Health’s Walk-in Model Takes Internet, Worry Out of the Vaccination Equation

The early rollout of the vaccination campaign was often marked by frustration over the process of making online appointments and subsequent worry about having appointments canceled when supplies didn’t arrive as expected. McLeod Health took those concerns out of the equation when they developed a walk-in model that used a voucher system to hold each person’s place in line for a guaranteed shot.

According to Octavia Williams-Blake, vice president for workplace health and safety, the walk-in idea was the brainchild of Kim McCracken, RN, Business Relations Director for occupational health, and the process was perfected by McCracken, Michele Dore, vice president for clinical integration and accountable care, and a detail-oriented team that figured out how to make walk-in vaccinations efficient. “We literally drew it out on notebook paper,” McCracken said. “We set it up as a production line, mapped it out on a Thursday and went live the following Monday.”

Initially tasked with vaccinating employees, the team quickly figured out that VAMS wasn’t ideal for getting people registered. They shifted to a third-party portal, which worked well for people who did not have email addresses and were uncomfortable using computers. When S.C. added the 70+ population, they decided to try a small-scale, walk-in clinic at their Florence location that wouldn’t require appointments.

“We were going to try to do about 125 people per day, and we had about 200 people descend on us within a couple of hours,” McCracken said. “We realized we could do it, but not in our current facility.” They secured an auditorium and the resources to staff it, getting immediate support from hospital administrators.

Logistics are well-orchestrated. There’s a mixing station for RNs whose only job is to prepare vaccines and a supply station so that everything the nurses need is nearby. Clerical staff handle check-in and a lead nurse monitors patient flow, troubleshoots problems and monitors the post-inoculation waiting area. Williams-Blake’s role is leadership support, “to be at the door, be available and be present. You will have people show up who are not eligible, and someone’s got to handle that so that nurses can focus on vaccinating people.”

Here’s how the voucher system works. The team generally knows by Friday what their vaccine allocation will be for the following week. “We take Florence’s allocation and print vouchers for that many doses, generally 750 – 900 per day. The voucher holds your spot.” The hospital website tells people how to pick up a voucher, and after an ID check confirms eligibility, they are given a voucher with a day and time to return. The shot is guaranteed to be available at that time, because the number of vouchers printed never exceeds the number of doses on hand.

Williams-Blake admits that the first few clinics felt like a post-Thanksgiving Black Friday event with people showing up hours in advance to make sure they got in line early, even with a voucher. “People were nervous, but now that they’re starting to understand that there is a dose for them, it’s getting better,” she said. Security officers keep early arrivers out of the facility until the staff is ready to open.

The largest day accommodated 1,250 vaccinations, but the process can also be scaled down for community-based events in outlying, rural areas or for targeted populations, such as law enforcement officers or teachers. Nurses will go out to a car or medical transport if a person can’t physically walk in.

Other logistics include using different entrances to help sort people into lines – those who have a voucher for the first dose, those who have a voucher for a second dose, or those who are arriving for a second dose without a voucher. The set-up has to take social distancing into account as well as accommodate people who need a walker, wheelchair or help from a caregiver or family member.

The response has been overwhelmingly positive, but the voucher system has some drawbacks, Dore said. “If it has taken all an older person can do to get to here for a voucher, only to be told that they have to come back in two days, they’re disappointed. If we have the flexibility, we’ll try to work them in. The main complaint is when we run out of vouchers. But that’s better than running out of vaccine.”

Every morning, there’s a safety huddle, and every afternoon, the team regroups to ask what worked, what didn’t work, and what needs to change. Planning, adequate staffing and continuous improvement are the keys to success, they said.