Connecticut has been leading the nation in vaccinating its citizens against COVID-19, and was the first state to reach the key milestone of half its adult population vaccinated. Contributing to the success of the state’s effort is a partnership between Yale School of Medicine and Yale New Haven Health (YNHH), which together administered the highest number of vaccines of any vaccination site in the state under a single Provider Identification Number (PIN). Yale’s success prompted a visit from the federal Centers for Disease Control and Prevention (CDC), whose staff wanted to see just how the Yale team was able to so efficiently vaccinate so many people, a figure that reached 411,000 vaccinations as of May 19.
In order to vaccinate people with the least amount of waste and the highest possible safety and efficiency, the Connecticut Department of Public Health (DPH) distributes the store of vaccines it receives from the federal government to a set of registered sites. Each site is assigned a PIN once it meets requirements that ensure that medical staff is in place to oversee the vaccine effort, that staffers involved are properly trained, and that facilities are up to the task of safely storing and distributing the vaccine. Achieving this and serving Yale’s eight vaccine sites required some creative thinking.
“We developed a hub and spoke model,” said Sarah Kelly, PharmD, YNHH system director of pharmacies and leader of the Yale COVID-19 vaccine enterprise. That is a system where the vaccines are carefully stored at a central location, and then distributed as needed to the sites where people receive them. Yale New Haven Hospital’s York Street Campus was selected as the “hub,” because of its central location and cold storage capacity in the hospital pharmacy. The Pfizer vaccine, for example, cannot be stored at room temperature for more than six hours. “We had to be creative and get it down to a tee when the vaccine can come out of the freezer,” said Kelly.
Radiating out from the hub, each of the eight “spokes” in the system had to operate at top efficiency to make sure the vaccines went where they needed to go: into people’s arms. “This type of model has been successfully used in other contexts at Yale,” according to Rebecca McCray, RN, YNHH director of clinical operations for the COVID vaccination enterprise, and the manager of the vaccine effort’s eight sites.
Two of the sites were developed through a collaboration between YNHH and Yale School of Medicine: Yale West Campus in Orange, and the Lanman Center at the university’s Payne Whitney Gymnasium. Other sites are at the University of Bridgeport, Mohegan Sun Casino in Uncasville, Mitchell College in New London, the Floyd Little Athletic Center in New Haven, the Parsons Center in Milford, and the Brunswick School in Greenwich.
The hub and spoke model led to a high level of throughput, which spurred DPH to allocate higher numbers of vaccine to the Yale PIN each week. “They continued to trust us,” said Kelly.
The West Campus and Lanman Center sites were offered free of charge to the vaccine enterprise by Yale University, said Yale Medicine Director of Population Health Brita Roy, MD, MPH, MHS, assistant professor of medicine (general medicine) and epidemiology (chronic diseases), who serves as a liaison between YNHH and the university.
“The West Campus site has been highly successful,” said Roy, “which is why we elected that the CDC visit that site. The site exemplifies the wonderful partnership between the university and the health system.”
“It’s more than just lending us a building,” said McCray. Yale Medicine physicians also collaborated with YNHH on the clinical side, working to develop standard operating procedures for the vaccine enterprise, as well as training. “Anything we have designed we have designed with a multidisciplinary team between us and the university,” said McCray.
According to Kelly, the CDC especially wanted to understand how the Yale sites so successfully manage the cold chain, which constantly monitors the temperature of the drugs from arrival to vaccination. To accomplish this, Yale uses TempTale technology, which includes a sensor attached directly to the drug supply and monitors its temperature throughout the journey from hub to spoke. “The CDC noted it as a best practice,” said Kelly.
During the West Campus tour, the CDC was also keen to view best practices devised by Yale on how to safeguard a vaccine distribution facility. “How do you know,” they asked, “that the refrigerators you use to store the vaccine won’t be unplugged?” The tour group went down to a West Campus basement, where they viewed a circuit breaker lock system devised by Kasey Baker, PhD, a strategist in the YNNH Enterprise Program Management Office who coordinates the West Campus site. “They said it was the best practice they had ever seen,” said Kelly. “They took pictures of it.”
Beyond photographs, a CDC team member received a more tangible souvenir of the West Campus tour. “One of the team from the CDC said ‘today is my second dose of Pfizer. I would love to have you vaccinate me.’” Kelly said. “And the team at West Campus did. That ended up being the best compliment we could have received.”
As the vaccination process continues, the team is not resting on its laurels, and is constantly honing its methods to keep Connecticut on top. “We are always talking about what we can do better,” said McCray. “And we are always evaluating what’s happening. If we meet at 8:30 and make a change, it will be implemented by 10. Nothing will stop us.”