Jason M. Worcester, MD

Class Year
1998

Specialties
Internal Medicine & Addiction Medicine

Current practice/Appointments
Medical Director, Adult Primary Care, BMC; Medical Director of ILI Clinics, BMC; Assistant Professor of Medicine, BUSM

How/when /why did the Influenza-Like Illness (ILI) Clinics develop at BMC & become fully operational? What was the goal? Who can come?

The ILI Clinic was designed in the early days of the pandemic to address the need for accessible testing for patients as well as an avenue to decompress volume going through [what we forecasted to be] an expected a busy emergency department in the coming days as of May 27. The clinic is set up such that patients walk-in typically with symptoms or concern for COVID-19. They are seen and evaluated by a clinician, either a nurse practitioner or physician. What we learned early in the days of COVID is that patients can look relatively well but decompensate pretty quickly. Thus we decided to have an assessment by physician or nurse practitioner rather than just a ‘swab and go’ clinic.

With the pandemic closing in on us pretty quickly, we devised and built the clinic essentially over the weekend of March 13th. It was a pretty amazing collaboration between leaders of Boston Medical Center, our clinical faculty at BUSM, the medical assistant team, patient registration, our IT team, security, legal, environmental services, and BMC security to name just a few of the groups we partnered with to get the clinic up and running in just a couple of days. We transformed the lobby of the Shapiro ambulatory care building into a testing clinic in short order.

How did you get providers to staff ILI Clinics? What departments did you draw from?

In the early days of the ILI Clinic, one of my biggest worries was actually ‘how am I going to staff this clinic?’ I thought it would be hard to convince clinicians to count up in PPE all day, interacting closely with patients who likely had COVID and then proceed to swab their noses. On first glance, it seemed like it would be a difficult recruitment process. I reached out to my own General Internal Medicine section as well as the Pediatrics and Family Medicine Departments here at Boston Medical Center. However, I was really surprised at the response I got. Numerous people signed up to be part of our clinic. In fact, we had too many people trying to sign up at times. Throughout the pandemic over the last few months, it has been really extraordinary to see people step up in all different ways. I saw that here first hand and leading our ILI Clinic, but people in my own group volunteered to be part of COVID inpatient services, take extra call shifts, jumping into help our nursing team answer calls from patients worried about COVID, and covering other clinical responsibilities of their colleagues.

Describe a few of the greatest challenges since March 1.

One challenge has been keeping up with all of the updates in testing guidelines either from the CDC or our local Massachusetts Department of Public Health. Guidelines and recommendations seem to change on a weekly basis. This required frequent updates to our own internal testing guidelines and keeping our faculty, as best I could, up to speed on all these updates.

An initial challenge that was quickly overcome was helping to allay fears of COVID transmission with our team. Our registration staff and medical assistant staff were obviously worried about interacting with COVID patients. They are on the front lines on a daily basis interacting with patients. But I found that working together with them and educating them on appropriate PPE, their confidence improved. In fact, our medical assistant team has taken the lead on the appropriate use of PPE and have been well equipped to educate new members of the team on how to don and doff the PPE.

Please share a patient story or two (or more) that stick out in your time in the ILI Clinics.

There have been a couple of patients that have stood out.

The homeless population in Boston has been hit particularly hard by the COVID epidemic. We would see a number of homeless patients come in for assessment and testing. With the fear of transmission and shelters, it has been difficult for patients with symptoms concerning for COVID or being COVID positive themselves to get adequate shelter. So if a homeless patient would come in and be tested, their ultimate disposition was unknown. This can be really scary as they may have nowhere to go. I recall when one patient come in. He was a 30-year-old homeless gentleman who developed cough and fever and had nowhere to go. We assessed him and felt that he was clinically stable to be discharged ‘home’ after testing, but he had nowhere to go until his results were back. Now our testing clinic is not set up for people to hang around too long, but we are able to keep him in our clinic for a few hours until his results came back and he could ultimately go back to his previous shelter with a negative test. This took a considerable amount of coordination from a very caring Boston for the healthcare homeless triage nurse.

I recall another patient to provide insight to how scary COVID-19 can be. The patient was an elderly woman who walked into our clinic complaining of cough and weakness. She walked in our front door and before she even got to the registration desk, she collapsed. The team sprang into action and quickly whisked her off to the emergency room. She was ultimately diagnosed with COVID-19. She was profoundly hypoxic. It turns out she was so afraid to come into the hospital because of fears of COVID that she put off her symptoms until was almost too late.

What is the role of the School of Medicine students at this time?

One critical piece of our clinic is result reporting. Patients leave the clinic with pending results. We have a central team that reaches out to patients to give them their results. As you can imagine, being a patient and waiting for a COVID-19 result can be distressing. When someone gets that call and that is a note that they are positive or negative can be really stressful. A nurse team has been reporting results now for the past three months as of May 27. As part of this, a few fourth-year medical students have joined the result reporting team. This is been an interesting opportunity to have our BU medical students involved in the fight against COVID 19.

Have there been any new developments with the ILI clinic?

Our clinic now has been operating for about 2.5 months as of May 27. We found the need to make some minor changes in workflow on a regular basis essentially as we try to improve our processes.

We have expanded the clinic to a second location here on the BU campus. With the expanding need to test our own BU faculty and BMC employees, we added a second clinic. This was interestingly set up in a previous restaurant. It turned out to be a perfect space for patient flow. We set up chairs in the main portion of the restaurant. Our registration desk is right by the valet station. The BMC facility’s team engineered a negative-pressure system inside the restaurant by jerry-rigging the ventilation hoods in the kitchen. We ended up with a highly-functional negative-pressure testing facility set up in just a couple of days. I will note that the Chinese food restaurant was vacated prior to the pandemic and is closed… No food is being served.

As the Medical Center is starting to open up and as the COVID-19 volume decreases and continues to decrease (hopefully), some of our testing operations have shifted towards doing preoperative testing of patients. COVID 19+ patients have a relatively high perioperative risk and so we really try to avoid sending patients with-COVID to the operating room. So in the past week as of May 27 we have set up a preoperative testing clinic. We have built this on lessons learned from our other testing clinics. This is a really good sign is our patients are now able to get to the operating room safely and get their conditions addressed.

Over the past two and half months, the ILI Clinic has seen over 2,500 as of May 27 patients. Most are negative, fortunately, some positive. Our youngest patient was 2 weeks old and we have had many patients in their 80s come through.

What message would you share with readers (alumni, students, general population) about safety?

Safety has been a primary concern of us from the start. We set up our processes centered on safety. There is so much we do not know of COVID-19 despite so many people looking at this disease over the last months so we have had to be extremely vigilant for both our patients and clinic team members. We have taken guidance from our infectious disease colleagues and infection control team members here at Boston Medical Center on appropriate PPE. The protocols around PPE are appropriately strict and must be followed to a T. Not trying to sound creepy, I spent some of my time just staring at the team members watching their flow, making sure they follow protocols. How they are processing the test samples…are they following the steps of donning and doffing of PPE? ….do they take their mask off in the right order? I found this to be very helpful in giving direct feedback to people regarding their own safety. It has created an open dialogue among team members. Everyone helps each other when it comes to safety. We are all looking out for each other.

What is the future of the ILI clinic?

This is a really good question. It will mostly depend on what the trajectory of the COVID-19 disease is in Boston over the coming months. We have fortunately seen a decrease in overall numbers, but we are worried about a second surge coming in the summer or fall. If there is a surge, I expect the ILI Clinic will be up and running at full capacity again

I hope ultimately to get back full-time to my ‘day job’ of being an Internal Medicine physician and Medical Director for a Primary Care practice here at Boston Medical Center. And not worrying about COVID-19, although I do not expect that for a while. Our Primary Care practice has been doing primarily telehealth visits over the past couple of months as of May 27. We plan to open up to see more patients in-person in the coming weeks. We expect this transition to be gradual as we all learn how to safely navigate in our new COVID-19 world. The plan for this is in itself, a major project. We have had to think differently about how patients come through our clinic with concepts of social distancing and use of PPE with visits that we have never done before.