How to Manage a Clinical Laboratory During the Pandemic

Connie Wilkins is a career laboratorian with a passion for all thing’s science, chemistry, and math. She started her path in the lab as a midnight tech and is currently the Interim Division Director for CHI Health, leading 15 hospital labs in Nebraska and Iowa. CHI is part of Common Spirit, one of the largest health systems in the U.S. with 150,000 employees, 25,000 physicians and advanced care and practice clinicians operating in 142 hospitals in 700 care sites across 21 states. We connected with Connie to hear about her perspective on the front lines of the current healthcare crisis, managing the department at the center of it all. She painted a picture of a timeline and the milestones along it. Some milestones are bigger than others and leave a mark in history, whereby all things following it are then measured as before and after. COVID-19 is going to be one of those milestones.

Prior to this, I was a laboratory director in Joplin, Missouri. We were actually the hospital hit by an EF5-rated multiple-vortex tornado that devastated the community. Over 160 people died. Our hospital was decimated. The real memory however is how we recovered. I could spend hours telling you how the lab, the hospital staff and the community rallied to bring back service over the next year. That was the most rewarding accomplishment when I look back because it took so many teams and so many communities to rise out of the ashes – together. I will always be proud of how we responded to that disaster. For me, everything since then has been before the tornado or after the tornado.

We asked Connie to share what this experience on her timeline taught her about building, and leading, a lab that is always prepared for crisis mode. She shared 5 principles.

Recovery

  1. Quality first. The laboratory provides information and that information predicts how caregivers are going to handle that patient. It must be accurate, period.
  2. Provide your staff the tools to be successful: Clear expectations of what you need, clear communication, continuous education, and training. Always be ready.
  3. Be aware of what is available and coming next. Automation should be a top priority alongside consolidation of doing the right test at the right location. You do not have to do everything, everywhere. Lean processes keep you prepared for increased volume.
  4. Staff to volume. You owe it to your system, to your hospital, to your community, to staff to volume with frequent evaluations. Stay connected to your staff to manage challenges.
  5. Your team wants to hear from you frequently. They need to understand decisions are made so they can take ownership.

While tragic, Connie’s experience has made her an extremely qualified leader in the face of the current pandemic. She leads with confidence because she knows there will be an after here as well. Connie shared her initial approach, and that of her hospitals, when before was fading into the distance this time around.

We put a lot of protocols in place just around access to the hospitals right away. We set up our incident command center with guidelines for redeployment of staff to screen patients or employees coming in the door. We diverted all clinic patients that potentially were COVID-19 or their symptoms or travel history fit criteria for concern. We increased the volume of virtual visits. We set up our website to allow patients who had a concern they were infected to be contacted for follow-up. And of course, we eliminated all elective surgeries.

While these all seems like standard steps, there were other factors across every hospital – in their before – that impacted response to this crisis. In Connie’s labs, it was the installation of a large automation line in their flagship hospital. While this was a strong, progressive move in building a sustainable, centralized model for Connie’s system of hospitals, the staff and billables set up at this location dropped almost immediately from close to 13,000 to 6,000 a month. Overnight, there was staff across departments with a patient census drop of approximately 60%.

We asked Connie to share her management of during this time around. She painted the picture of chaos – the first positive COVID-19 patient makes the news, there’s a press conference, and everyone is panicked. Almost instantaneously, an influx of patients come to the Emergency Department.

 Crisis Management

  1. Call Center: We put in place a phone number that patients could call if they felt they were infected with COVID-19. The message was clear: Do not come to the ED if you suspect you have COVID19, unless it is a true emergency. Call this number first.
  2. Central Clinic: We set up a large clinic in Omaha for all potentially infected patients. At this time, our laboratory was not performing COVID-19 testing, only the state health departments were, and the guidelines were rigid.
  3. Protocols for Testing: We had three protocols in place, depending on your point of entry into our system – ED, inpatient or clinic setting. If the answer were yes to do testing, the next steps were dependent on this location. With, or while waiting for a PUI number, our labs would perform a respiratory pathogen panel. Only if it were negative could you then send it to the state health department for testing.
  4. Staff Management: We coordinated with the division incident command to identify staff that could do other things outside the Lab to support our health system when volumes were low (early on) and reciprocated this effort when testing ramped up.
  5. Tracking Results: It is imperative to follow a test sent to the state health department. A PUI patient could come back positive and managing the logistics of tracking the result to the ordering provider, caregiver, patient chart in a timely manner is essential to mitigating this virus.

While furloughs began in health systems across the country, CHI Health made every effort to redeploy team members with transferrable skills, and an innate passion to help. This allowed Connie the opportunity to focus on bringing up COVID-19 testing in her lab which was no easy feat.

We started performing COVID-19 testing in our molecular laboratory on the Abbott M 2000 in March – the high complexity, labor intensive, testing and we only had two people trained on the platform. We immediately started to train more staff but, because we were also in respiratory pathogens season, we had to perform a respiratory pathogen panel prior to any COVID-19 test. While volumes were down, we now ironically had a testing need that required more staff, more expertise, more training, and more supplies – so many more supplies. There were many potential break points – just one break could inhibit  the labs ability to perform COVID19 testing. It really had to be a coordinated effort between our laboratory staff, our medical directors, and the supply chain to make sure we were fitting all the pieces together. The teamwork and support of the hospital system outside the lab was phenomenal.

As no one knows when after will truly be defined for COVID-19, Connie is focused on during, providing testing without interruption since March 27th, adding and managing supply issues with a newly created dashboard accounting for real-time test kit use. She continues to refine plans for recovery – and preparedness – in parallel, adding 3 additional testing platforms to maintain testing levels despite supply chain issues. She remains confident standardization will return, and her lab will remain ready, stronger, and able to meet the needs of its communities, no matter the timeline.

Connie Wilkins

Connie Wilkins

Lab Director, CHI Nebraska