Examining the Life of a Swab

Neither rain nor snow nor heat will hinder the swift delivery of COVID-19 test results at Cincinnati Children’s. But testing for COVID-19 takes much more than a 10-second swab out in the elements to turn around results in three days or less. Many hands play a part in planning, scheduling, registering, processing and sharing results with our patients, families and staff.

Since March, we have tested thousands of people for COVID-19—more than 86,000 as of Jan. 5. We saw about 9,500 patient tests and over 2,400 employee tests per week in December alone. Testing demands have continued to climb as numbers surge in Ohio, and hospitals are seeing the highest number of COVID-19-positive patients being admitted and cared for in our region’s intensive care units.

Discover what it’s taken to bring pop-up testing to our sites and the village behind it.

Ordering a Test

So, you don’t feel well. If you’re an employee, you call 803-SAFE, to discuss your symptoms with a safety hotline agent to determine if testing is needed. On their highest days, a team of nurses and paramedics fields 900 calls, when they were used to getting around 40, pre-COVID.

“Our team has grown but not as fast as call volumes,” said Brianne Finch, manager, Drug and Poison Information Center (DPIC).

Half the day, Finch and the rest of the 803-SAFE team schedule employees for tests. The other half, they deliver results and clear employees to return to work, following a negative COVID-19 test or the resolution of symptoms.

It’s been a process built from the ground up with architects from Information Services within DPIC. Using Microsoft Flow and collaborating with Employee Health, members of DPIC created a new system to generate lab requisitions, schedule appointments and send email confirmations.

If you’re a patient, the order begins with the primary care physician. Physicians inside and out of the hospital use newly created order sets in Epic or Epic Link to quickly request symptomatic testing at a drive-through location, asymptomatic testing or a rapid (or Stat) test prior to surgery. Some community physicians remove a step from the process by swabbing patients right in their office and sending specimens by courier.

Once the order is received by the Lab, then you’re ready to schedule an appointment.

Scheduling an Appointment

Dustin Carter, lead representative, is who you might encounter next as a patient. He’s one of our 65 schedulers, answering incoming calls to our COVID-19 testing hotline or calling families to schedule appointments, if ordered internally.

“Today (on Dec. 8), real time number, we have had 484 calls as of 2:30 pm,” said Carter. Involved since the beginning, he has adapted over time to the increasing call volumes and shifts in operations to provide same-day and next-day appointments to our patients and families, sometimes pulling in the Behavioral Safety Team for those who may require special assistance.

“It has been a rollercoaster. Every time we think we have it under control, we get another huge spike,” he said. Listening to what’s happening on the frontline, the Scheduling Center has been able to make changes to their hours of operation and staffing to keep call wait times low.

The largest shift, however, came when the team abruptly moved their entire operations home after social distancing and observing split schedules while working on campus. The move to remote meant getting equipment out to all the schedulers and finding new ways to virtually check in on team members handling a rush of calls.

Collecting the Specimen

You’ll find Tyler Crisp, RN, at one of our drive-up testing sites if you’re a patient or an employee. She’s been to them all since she started doing COVID-19 testing in July and has seen the weather and our process evolve from season to season.

When you arrive, Crisp, another nurse or a patient care or medical assistant will ask for your name. After finding your label, the team checks that it’s the right specimen for the right label. Your name and birthday are verified again. Then, she’ll get you ready for what you’re about to experience before swabbing your nose or one of our patients.

“My mind is always thinking: What’s the best way to hold? How am I going to comfort this kid? Will the older sibling be a better example than having the younger sibling go first? Are the parents going to hold? Should we grab backup?” Crisp said. Her involvement has taught her to speak up about her needs to keep everyone safe and learn and adapt her technique to the situation.

Based on valuable input from Emergency Department staff, Crisp changed how she holds babies when swabbing from a car and now puts the baby’s arms over her head, like we do for other procedures. “He can’t move his head around,” Tyler explained. “I don’t know why we didn’t think of that from the beginning.”

Following swabbing, gloves are removed. The face shield and hands are washed, and the specimen is deposited into a cooler. Specimen collection occurs about every hour. At Mason, which tests seven days a week, the team currently can collect about 350 specimens in 12 hours.

As demand has ramped up, so have we. Days, hours, and locations for testing have fluctuated with the needs of the community.

“We have been committed to looking over the horizon and anticipating what could be coming down the pike, next week or next month,” said Jeff Simmons, MD, safety officer, James M. Anderson Center for Health Services Excellence, and the physician lead for testing.

At Green Township, Medical Assistant Kristen Korte started out testing once per hour, which equated to nine appointments per day. Today, the team is testing every five minutes. Logistical help from Information Services, Grounds, and Parking and Transportation made it all possible by acquiring county permits to add a tent to the lower parking lot, setting up a mobile office pod to shield employees and keep supplies close by, and extending our wireless access outside of the building to document testing and print lab requisitions.

“We have the only COVID-19 testing in the region that has remained outdoors,” said Jillian Burkhardt, project administrator. “This is a huge satisfier for our patients and families.”

Behind the Scenes of COVID-19 Testing

With testing tents popping up around our campuses, our Grounds and Facilities teams hit the ground running to support our COVID-19 testing team. They began setting up our COVID-19 testing stations and tents on top of their day-to-day hospital duties, including: mowing, landscaping, garage maintenance, cleaning, mechanics, and irrigation on all campuses. From creating directional signage in our parking lots to implementing the new mobile office pods at our testing sites, Facilities and Grounds have been an instrumental part of allowing our COVID-19 testing process to run efficiently.

As testing sites were set up, our Information Systems (IS) team knew that they would need to get involved. With most testing sites outside, IS was faced with the challenge of creating a space outside that served as a hybrid workstation and office space for our COVID-19 testers. IS rushed to provide hardware, wireless access and tools in Epic to ease and assist in the COVID-19 testing process. IS’s work has allowed our providers to focus solely on our patients.

With over 5,000 hours dedicated to COVID-19 project requests, our IS Team has been able to support our COVID-19 testing team and Cincinnati Children’s as a whole.

While these teams’ tasks, duties and titles are so different, they all rely on each other for collaboration. It is because of teamwork and partnership that we have prevailed through the COVID-19 pandemic and have come out stronger and better as an organization.

Getting Results

Once the specimen arrives, Shelly Hinrichsen, clinical lab manager, and her Lab Support Services team log it or complete the registration that allows us to bill the patient’s insurance or Employee Health. Then, they get the specimen to the right lab for the right testing. Generally, if it’s a Stat test needed before surgery, the order goes to Microbiology for immediate processing. If it’s a PCR test, Molecular Pathology typically runs the results.

In the labs, staff have pulled together to work extra shifts, extra hours and to cover weekends to keep up with volumes and maintain our quick turnaround of results within 3 days or less; commercial labs give a five- to seven-day turnaround. We also serve as one of the testing sites for the Ohio Department of Health.

“That’s what the patient needs, that’s what the families need to react to that potential positive result,” said Meredith Taylor, operations manager, Pathology.

Supply issues have tried to hinder their success, though it has eased up.

“Allocation became what we were living and breathing,” said Taylor. “Early on, because we were pediatrics and because we were in Ohio, not a hotspot like New York, we didn’t rank on vendor lists to receive basic supplies and reagents.

“We got Emergency Use Authorization for our own lab-developed test. We made do with what we could. What different swabs could we use? What different pipette tips could we order? Our staff is resourceful. Researchers even manufactured viral transport media when it wasn't available to enable the collection of specimens.”

Along the way, the team has found efficiencies for quicker workflows and learned the importance of having redundancy in our instruments, according to Barbara Deburger, clinical labs manager, Microbology. High volumes have required the testing team to continually run instruments throughout the day moving various testing from shift to shift.

Labs and divisions across the medical center have pulled together to help the core team of 40 Pathology and Microbology members. Genetics and Anatomic Pathology staff volunteered to get trained in how to run PCR tests. Others have lent supplies like pipette tips when a shipment doesn’t come in or an item is suddenly on back order. Countless more, including administrators, have pitched in to enter about 250 faxed orders and make phone calls to report positive COVID-19 tests to physicians.

Following a positive test result, Infection Control notifies public health. The team has automated reporting to meet federal and state requirements thanks to help from Information Services. Infection Control also conducts contact tracing to identify possible infection risks within our environment to maintain the ongoing safety of our operations.

Testing as Vaccines Rollout

Out of necessity, a testing process was quickly formed and continues to be reinvented and refined, sometimes daily or weekly. Like many aspects of the pandemic, it has underlined our strength to collaborate and uncovered a deep appreciation for collaborators, old and new. Many voices at the table have informed decisions about changes to the process and any potential downstream impact—adding more testing appointments, managing increased prevalence in the community and more.

“This is such a labor of love from so many areas,” said Karen Tucker, RN, assistant vice president, Patient Services.

Vaccines have brought hope in sight, but we still have more testing to do. The entire testing team urges staff to continue to take precautions to help manage volumes. Masks, social distancing, working from home, hand hygiene, daily self-screening and staying home when sick are all part of the overarching strategy to stay safe.

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