Delivering Hope: The Scripps Del Mar Vaccine Super Station

Scripps is no stranger to disaster response. Its medical teams had pitched in after 9/11, Hurricane Katrina and the slew of devastating wildfires that ripped across Northern California two years ago. It was time to draw upon that experience once more. 

The dozen or so small vaccination sites across the Scripps system that were administering a few hundred shots a day just didn’t have the capacity to handle a large volume of vaccines, nor did their successors at Scripps hospitals. So, Scripps worked with the County of San Diego to ramp up its vaccination efforts at one of the most expansive locations around: the Del Mar Fairgrounds.

“Each time we opened up a vaccine clinic, we actually designed them a little bit differently,” says Chris Van Gorder, Scripps president and CEO. “Each time we learned better and better how to lay out the logistics so that patients were not inconvenienced.” 

That technical know-how, along with cooperation from nearly every facet of the Scripps system, made possible the Scripps Del Mar Vaccination Super Station. The massive drive-through and walk-through clinic opened February 12 with nine lanes, each with three vaccination sites, meaning 27 people can be vaccinated at a time. 

Van Gorder says the Super Station can administer up to 10,000 shots a day. In fact, 5,300 were efficiently given in just four hours. The issue is having the supply.

The Super Station’s capacity ultimately depends on the number of vaccine doses available, and in the first few months’ supply was insufficient to meet demand. Word of the Super Station’s next allotment comes just a few days in advance, and since Scripps doesn’t manage the overall vaccine supply, there’s no way of telling how much of this “liquid gold” they’ll receive from week to week. 

Unforeseen problems can be especially frustrating, like in mid-March when a glitch in the state’s scheduling software left the Super Station overbooked by more than 1,800 appointments. Scripps reached out for more vaccine but was unable to get it. They then had to tap into the supply needed for later that week, adjust staffing levels to accommodate the extra patients and reschedule those whom the redirected vaccines were originally slated for. And believe it or not, the clinics have quite a few no-shows, which creates a whole new issue because Scripps is required by the state to give out every single dose. 

“Every week is a bit of a numbers game,” says Ghazala Sharieff, MD, Scripps chief medical officer, acute care, clinical excellence and experience. “You cross your fingers and hope you get enough doses to come in.” 

Fortunately, Scripps had been able to test out a few different models at its earlier clinics and prepare as best they could to apply them at a larger scale. They also learned from other super stations: To deter people from showing up without an appointment, hoping to receive a dose leftover at the end of the day, they set up a waitlist of eligible people who could be summoned if and when that happened. “The advantage of being at Scripps is that we are very nimble,” Dr. Sharieff says. 

As the hours and cars go by, one thing remains certain: No two days are ever the same. The consistency of the Super Station’s vaccine allotment drives everything — from the number of vaccinators and pharmacists needed to which days the Super Station will even be open. “We’re constantly changing the model,” Meyer says. “We adjust it almost every day and try to see how much more we can get out of it.” 

“We’ve got a culture of constant learning,” Collins adds. “We try to put one step in front of the other every single day to greater benefit our community.” Traffic patterns also change from day to day, and staff members must confer with one another and their counterparts at the fairgrounds to prevent backups. “There’s no playbook for this thing,” says Peterson. “But Scripps is an organization that excels at creating trust and working together through its teams.”

In an operation this complex, it’s easy to get lost in the details—but like any other service Scripps provides, it ultimately comes down to patient experience. “One thing I always remind myself is: As we’re continually improving, we are really hard on ourselves because we see this every day,” says Cole. “At the end of the day, when you go talk to our patients who’ve received the vaccine, they are celebrating.”

From a patient’s perspective, the process of getting vaccinated goes something like this: They pull into the Super Station; they’re directed by traffic control and security to an area where their registration and reservation are confirmed; they enter the vaccination lanes, pull forward and receive their shot; then they drive to a waiting area where they are monitored to make sure there’s no adverse reaction. Most patients who come through the Scripps Del Mar Vaccine Super Station are in and out within 30 minutes, including the 15-minute observation period.

When it’s all running smoothly, there’s little hint of the complex logistics going on behind the scenes. Scripps pharmacists have an especially crucial job. Many other vaccines come to health care providers already measured out and loaded into syringes, but not the COVID-19 vaccine, which is delivered in multi-dose vials that must be kept very cold. Each vial contains enough for five doses with a little left over — six if drawn with absolute precision. Not wanting to waste any of the precious vaccine that we’ve all anticipated for so long, pharmacists must fill syringes very quickly and with the utmost accuracy. 

The vaccines can be kept at room temperature for only a short time and must be used right away. They cannot be refrozen. As soon as six syringes are filled, they’re rushed out to the person administering the shots, who waves an orange flag when they’re ready for the next batch. 

This massive undertaking required staff and volunteers to switch from using Scripps’ electronic patient records to My Turn, the state’s scheduling system. Chief Information Officer Shane Thielman says staff had less than 48 hours before the Super Station opened to learn the inner workings of that system, to ensure it could effectively deploy the high-capacity model they’d designed. They also had to field technical difficulties without affecting the patient experience. “It requires a lot of agility to make sure that we’re responsive and the community doesn’t perceive any hiccups in the way the clinic operates,” Thielman says.