In the era of COVID-19, there is a surge in demand for outpatient testing for the virus. When doing tests for regular influenza, patients generally come into their physicians offices and get a nasopharyngeal swab for a flu test in the physician’s office. But with COVID, it is necessary to reduce contact of suspected patients with other patients as well as with office staff. Furthermore, testing requires specialized masks, face shields, and disposable gowns that are generally not available in regular physician offices.
To meet the demand for testing while protecting our healthcare workers and community, we developed drive-up “swabbing stations” to do the tests. The goals were to minimize the time that patients were present in the testing area and minimize the staff exposure to the patients.
The challenge is that in order to track, log, and report tests, a patient must first go through a registration process. Furthermore, in a time of shortages of testing materials, testing needs to be limited to only those people who really need to be tested and not asymptomatic people who are anxious about the pandemic.
Our process was to establish a COVID-19 call center. Patients with symptoms contact their physician who then transfers or directs the patient to the call center. Volunteers in the call center ask the patients scripted questions to determine who requires testing and who does not require testing. Patients meeting testing criteria are registered in the electronic medical record and an order is entered for the test. That order is routed to the patient’s physician, or if the person does not have a physician, it gets routed to a designated physician in our health system – as the medical director our hospital, that often means me.
Patients are told to drive to a specific location and look for innocuous colored signs with arrows labeled with non-specific wording so as to not attract people who just show up without being screened and registered over the phone. They pull their car up to the testing station and a nurse with proper personal protective equipment comes to their window, confirms their identity, performs a nasopharyngeal swab, and the patient drives off. Patients who appear ill are directed to go to the emergency department; others return to their homes.
At our hospital, we chose a side entrance with a covered entryway that in past years led to the emergency department entrance but now is used as a drive-up/drop-off area for ambulances to bring hospital transfer patients to our hospital. We set up a second swabbing station in a parking lot on the University campus that was vacated with University classes all being converted to on-line during the outbreak. This second swabbing station was created using a portable enclosed tent with the ability of several cars to pull up simultaneously on either side of the tent.
The process is that once the patient is registered into the electronic medical record and the order is placed by the call center staff, the patients drive into the swabbing station and call the swabbing station phone number. Staff in the interior of the hospital entrance then print up patient labels for the specimens, pre-label the specimen tubes and then pass those tubes out to the nurse wearing personal protective equipment. That nurse goes to the car window and obtains the nasopharyngeal swab. The patient drives away and the nurse comes into the building and deposits the tube containing the swab into a plastic isolation bag held by another hospital staff member wearing PPE. Another staff member then takes the specimen to the lab for the test to be sent out to a commercial lab (we are currently doing tests on inpatients and employees with our internal hospital test and sending out the outpatient tests to a commercial lab).
I called one of the patients who tested positive over the weekend. She and her husband had returned from a trip overseas the week before. Her husband had mild cough and low grade fever that had since resolved. She had a bit more cough and fever to 101. Because the test takes a few days for the commercial lab to run, by the time her test came back, she was already recovering and no longer had fever or cough. She commented on how smooth and efficient the process went and how upbeat and encouraging the swabbing nurses were.
In Central Ohio, we are still early in the outbreak and the virus is not as prevalent as other parts of the world. Thus far, we have performed 3,000 tests, 1,146 of which have which have been completed. Of these completed tests, we have had 50 positive tests meaning that 4% of tests are positive and 96% are negative. We expect this to change in the next 2 weeks.
March 24, 2020
