Just as many schools around the nation began shuttering for the year last month due to the pandemic, top officials at Children's National Hospital were quickly mounting their own response to address COVID-19 concerns among kids.
"We heard from our pediatricians in late February, early March that they were very worried about what they were seeing in the community," said Children's National Chief Operating Officer Kathleen Gorman during a virtual roundtable with FierceHealthcare this week.
"Our community physicians shared with us that they experienced challenges in safely evaluating and managing what they were concerned was an early cohort of COVID patients in the Washington D.C. area, but they were unable to really determine if they were COVID-positive or not because the testing was not available," Gorman said as part of the discussion with Joelle Simpson, M.D., Children National's medical director for emergency preparedness, and Meghan Delaney, D.O., chief of pathology and lab medicine.
By March 13, Children National's CEO Kurt Newman, M.D., deputized a team at the 323-bed hospital in Washington, D.C. with the job of pulling together a drive-thru specimen collection site for testing children for the virus—and gave them a week to do it.
They started by securing a parking lot location, donated by local partner Trinity Washington University, to create a space for drive-thru testing. They set it up so specimens would be sent offsite to the program’s laboratory partner, Quest Diagnostics, for analysis.
The effort was supported by more than $1 million in fundraising from philanthropists including Scott Nathan and Laura DeBonis and matched by the A. James & Alice B. Clark Foundation, the Bharti and Raj Shah Family and Abeer and Yousef Al Otaiba.
1. Be intentional about the entire process: Space is at a premium for Children's National, which is located in an urban setting. But nearby Trinity had a portion of their parking lot which had a perfect area.
"We joked that when we went to see the Trinity site, it felt like it was built for drive-through testing,” Simpson said.
Knowing they were going to be serving pediatric patients, they did not want the grounds to be so open that a child that might have stepped out of the car, for instance to use the bathroom, might be at risk for being hit by a vehicle. “We wanted to have a narrow guidance through the site with one entrance and one exit,” Simpson said.
In the parking lot area, they set up a first checkpoint area to make sure those driving in had a referral from their child’s doctor to get tested. That is also where they signed consent forms.
Cars were then directed to a second checkpoint where their documents were verified before being directed to a testing station. At that final station, documents were scanned, specimens were collected and finally stored. Finally, they made sure to have a safe space for storing the samples and port-a-johns for visitors to relieve themselves.
Beyond that, she said, they made sure one of the tents was made with the capability for walk-up testing “because we know a lot of our residents of the DMV do not have cars.”
Before they officially opened the site, they hosted a pilot with patients referred from a small handful of doctors to make sure each step of the process worked.
The testing site is now open three days a week between the hours of 10 a.m. and 2 p.m.
2. Create a referral process—and don't forget a way to return the results: The team started by creating and sending clinical screening guidelines to community physicians.
They required a referral from a primary care physician with an electronic signature for patients to get a test. Referred patients were required to show the referral from their physician along with photo identification in order to enter. (Note: That electronic signature allowed a fairly accurate count ahead of time of how many patients to expect as early as the day before the testing opened, the Children's National team said.)
After Quest Diagnostics completes the testing, they return the results to Children's National, Delaney said.
"We took a belt and suspenders kind of approach to the return of results because we wanted to make sure that this incredibly important lab test was returned in a timely manner," she said. When they receive a positive test, a member of the team calls the associated primary care physician while negative test results are faxed over later.
"That’s been something that is a bit of a backend piece of work that’s a bit invisible when you’re thinking about doing this," Delaney said. "But it’s incredibly important because we spend a lot of time pulling off getting those tests completed, but you want to make sure you can as timely as possible get those results to the provider so they can inform the family."
That call to primary care physicians not only ensures results get relayed more quickly, but also closes the loop on information the individual physicians need, she said. "Often when I’m talking to the provider, I send this document about how to counsel the family that they’re about to call," Delaney said. "Every single provider I’ve called has said ‘oh this is the first one for me; I haven’t had to deal with this,' and they want to get some advice from us.”
"Our teams are working, they’re creating and they’re trying to solve for some of the big challenges we have not only for today but that we know we’re going to have coming up in the weeks ahead of us," Gorman said.
Beyond that, she said, health systems can serve as conveners in a crisis like this, Gorman said. “People want to help. Whether it is bringing the food to the testing site or bringing philanthropy support and donor support in a financial means, those are all things your community are going to want to do so don't be afraid to ask your community for help."
She also suggested the importance of connecting with community primary care physicians.
"They're at a loss. They're out there. They feel isolated. They feel they're not getting the PPE they need. They need to be connected to a health system," Gorman said. "So reaching out and connecting with those primary care providers, whether it be on the adult side, the pediatric side, et cetera, is critically important."
Want to see what the testing site looked like? Check it out in the FierceHealthcare Virtual Roundtable with Children's National.