Like many outpatient medical practices, Middleton Family Medicine needed to revamp its infection control procedures to continue serving patients during the pandemic.

But what started as temporary measures in response to COVID-19 have become more permanent fixtures of the practice, including an independent structure for drive-up testing and vaccinations and a separate-entry exam room that keeps potentially infected patients out of the waiting room and other medical office spaces.

In March 2020, Middleton Family Medicine, which serves 20,000 patients in communities north of Boston, erected tents to isolate and care for potentially infectious patients, providing both drive-through testing and temporary exam space for people suspected of having COVID-19.

By September, Middleton moved the exam room function back into the main building but added a door to the outside so that potentially infectious patients, identified in advance by phone screen, could be seen without traversing the waiting room and other areas of the office.

On arrival, patients call the office and receive instructions for how to enter the exam room from the parking lot. At the end of the visit, patients exit outdoors and check out by phone. Depending on the clinical situation, the provider can enter and exit the exam room from the interior or exterior door. If they require PPE, equipment stations for clean and used PPE are available in an adjacent room, which is also accessible from outdoors.

The tented drive-through testing facility has also undergone a transformation. It was replaced earlier this month with a permanent outdoor canopy attached to a climate-controlled room with rigorous air-filtration where samples are processed and vaccines are stored. The new drive-through facility offers testing by appointment for strep, influenza and respiratory syncytial virus, in addition to COVID-19. Instructions available on the practice’s website explain the process, including when and how patients will receive test results.

The practice also uses the drive-through facility for routine pediatric vaccinations and flu shots and plans to use it for COVID-19 vaccination. With appropriate freezers and protocols developed in weekly meetings, the practice is ready to offer COVID-19 vaccines as soon as they are available.

The practice continues to use telehealth visits whenever appropriate, something they have been doing since 2017 though on a much smaller scale. The practice saw usage jump from 130 visits in February 2020 to 5,000 visits in March. Usage remains high, with a total of 20,000 telehealth visits in 2020. Mark Allara, M.D., a physician at Middleton Family Medicine, reports that the rapid increase in March 2020 “was an easy transition because we had experience with telemedicine and systems in place.”

Dr. Allara encourages other practices to think outside the box. “You don’t know what you don’t know,” he says. “Two of our core values here at Middleton Family Medicine are to anticipate future needs and be relentless about improvement, which motivates us to do what's best for our patient population.”

Thank you to Jeffrey Oakes for his help with this story. Oakes is a candidate for the masters of public health degree at Tufts University School of Medicine.