It is one in the afternoon and Carlos, about 45 years old, arrives at the door of the Las Rejas health center in San Blas. Before entering, a nursing assistant triage him. He asks him "why he is coming" and if "he has felt bad in the last month, with a fever", to find out if he can have Covid. Carlos, worried, shakes his head: «I have been in pain for a day in my kidney area and I saw a little blood in my urine this morning. I did not know if you were open and I have passed ».
A cardboard heart that reads "Public Health, Thank You" decorates the table where the temperature is taken and Carlos is given hydroalcholic gel for his hands, who is treated by one of the three doctors who visit him - two for regular consultations and another for potential cases of Covid-, in a health center at that almost deserted hour. Carlos goes directly to the non-Covid circuit, where the rows of seats are placed "in cinema mode", looking at the consultations, to favor the safety distance. At one end, separated by partitions, is the Covid area, and also separated from the other two areas is the pediatric waiting room and the emergency room.
Surely Carlos is not the only one who has wondered if the health centers have been open all this time. The answer is yes. And although they attended and attend emergencies, they have worked mainly by telephone. This protocol has allowed Primary Care to be a retaining wall against the pandemic with the diagnosis, isolation of cases and monitoring of patients, preventing many from going to the hospital.
"We need to be called first"
"We have always been here and we will continue to attend", explains Gema Collada, family doctor and director of the health center, "but we need to be called first and tell us what's wrong". The User Service Unit manages that call, your nurse or doctor calls you, sees what the problem is and decides "if you have to go to your home, or make an appointment to come to the health center." "The population has been very responsible, the one that came was because they were very ill, or they were very ill," he says.
Since the start of the pandemic, this has been the protocol, which has reduced face-to-face care by 75% in this center and in practically all the 430 primary care devices in the region - 266 health centers and the rest of the clinics. «At the beginning of all this we had to dismantle what was there, adapt the spaces and equipment; It was a tremendous organizational effort to dedicate ourselves almost exclusively to Covid, and now little by little we return to our usual patients, "recalls Rosa María López, a nurse and chief nurse, who recalls" the uncertainty "of the early days.
Reorganization
In mid-March, in the management team -Lopez, Collada and María Teresa Cardenal, head of the User Service Unit-, in the midst of the maelstrom, they had it clear: «We had to move forward, without stopping, we saw what We needed, we reorganized the teams and in 48 hours we had the organization. The team has responded brilliantly, and has worked closely together, " says the director. The first thing was to enable the triage and blood collection areas, with the respective security measures, reorder the waiting banks, and strengthen the telephone consultation, something that is currently maintained , and where patient screening is carried out. "We did not encourage them to come because we wanted to avoid infections, but we always gave them coverage," says the head of the call center. "If we knew they could have problems, we would make them come here," says the director of a period, at the peak of the pandemic, where patients were not seen by their referring doctor, but by the one who was there that day. "With so much volume, it was impossible for your doctor to see you."
Meanwhile, home visits have been carried out "mainly" by Nursing, who "knows these patients very well." "There were patients, who had to be cared for at home, due to their underlying pathologies, so that they would not become infected," they explain. Despite the fact that the center focused on Covid, "we have had a lot of chronic pathology," says the director. All the patients who arrived with suspicion of having the virus were treated with protective suits. "We will continue to use them." If they were mild Covid cases, they were sent home and followed up by telephone every 48-72 hours, and if they were serious, they were referred to the referral center, the Ramón y Cajal Hospital.
Triage always at the door
At 8 in the morning, as usual, the center was opened to carry out the blood draws, collect samples, and do the PCR tests on the possible Covid, in a room separate from the usual analyzes. Patients were waiting at the door to be called. "At the door, there is always someone of ours," say those in charge of the center, who from 8.30 already attended consultations "every ten minutes" -the appointments were spaced so that at most there was only one patient waiting. "This way we prevent them from accumulating, it was more agile."
The de-escalation has started for about 10 days, although many protocols will be maintained. "Triage at the entrance, although some already come triads, is essential." The "spacing of intervals between patients and between consultations" will also be maintained, leaving an empty room in between, and intense telephone service will continue. GPs have returned to their usual patients, which is "the most appropriate thing", and pediatric check-ups and vaccinations for people over 15 months will soon be recovered, something that stopped in its day. Next, the on-site care "for chronic patients" that has been carried out at home will be resumed. "We still have a way to go," they argue, while they are clear that the seating protocols must continue.
They consider that there are many lessons learned, "things well done" that must be continued, such as "the telephone consultation, which is very useful and cannot be missed." In fact, all three specify that telephone attention has allowed «to know more about the patients». «We are more in contact, it is a positive thing, we know more about them, about their family environment, about how they sleep, by telephone you collect information that you may not take otherwise. We are closer even if we are not seeing them ». And their faces light up when they remember the "illusion" that the round of calls made to patients who have not been in the center in recent weeks to ask how they were doing. They called everyone.
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