QUERI – Quality Enhancement Research Initiative

QUERI E-news
May 2020

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Creating the First Mobile COVID-19 Testing Team

This COVID-19 drive-thru had three stations: 1) initial identification, screening, and brief triage; 2) clinic check-in and printing of specimen labels; and 3) vital signs, swabbing, and additional triage.

Takeaway: The first VA COVID-19 Drive-Thru testing site was opened through teamwork. This rapid response to the pandemic was possible because of a healthy clinical and research partnership consistently supported by local clinical and operational hospital leadership teams.

The Long-Term Care QUERI Program worked with several partners to develop the first Mobile Testing Team for COVID-19. Dr. Cari Levy discusses their rapid response in the early days of the pandemic.

The text on my cell phone read: “Adrienne needs help – let her know if you have some bandwidth.” My husband was in the mountains, I was sitting alone in the basement reviewing charts, filled with anxiety, uncertainty, and dread about what this pandemic had in store. I needed a distraction and wanted to feel useful, so I reached out.

The next morning my colleague, Michael Ho, MD, cardiologist and co-Director of HSR&Ds Center of Innovation for Veteran-Centered and Value-Driven Care (Seattle-Denver COIN), also had heeded the call. We listened as Adrienne described her vision. Adrienne Mann, MD, is known for her ability to organize complex tasks within the Rocky Mountain Regional VA hospitalist group. In the early days of COVID-19 preparation, she identified the need to start a Mobile COVID-19 Testing Team. She wanted the team to be able to travel anywhere in the hospital a test was needed.

Members of the Denver COIN really answered the call for volunteers. Tom Glorioso, MS, an analyst for the COIN and VA Clinical Assessment, Reporting, and Tracking (CART) programs, pulled VA data each morning on the COVID tests done and results for delivery to the Incident Management Team. Overseen by Paul Varosy, MD, a former HSR&D Career Development Awardee, a group from the COIN  (Heather Gilmartin, Rachel Johnson, Lynette Kelley, Michaela McCarthy, Kelty Fehling, and Brianne Morgan) called patients to assess symptoms after they were discharged from the hospital with COVID or suspected COVID. A group of medical students also volunteered to call Veterans about negative COVID test results 7 days a week. Meanwhile, Tammi Overton, RN, and I started the Mobile Testing Team. We reported to various locations throughout the hospital (i.e., dialysis unit, outpatient clinics, hospital wards), as needed, to teach others how to test and document. Our goal was to educate others such that our team would eventually no longer be necessary.

As the emergency department (ED) prepared to respond to the surge of ill Veterans, leadership became concerned that COVID demands would overload ED resources. For example, if patients are tested for COVID-19 in a clinic or hospital room, the room cannot be used for at least two hours while it is decontaminated. The Incident Management Team then worked to create a COVID-19 drive-through testing site to help relieve the burden on the ED.

Over the course of a few days, a temporary shelter was constructed in one of our parking garages, supplies and equipment were acquired from every department of the hospital – from interior design to environmental services – and 30 staff organized the “Swab Squad.”

the Swab Squad

Three stations served Veterans and staff who drove through to obtain testing throughout the day. While the drive through aspect was different, the documentation and reporting remained largely the same as the procedures initially developed and the transition was smooth. Ms. Overton established another drive-through in Colorado Springs to serve Veterans at a neighboring CBOC 90 miles south of the main VAMC, and Drs. Ho and Varosy scaled their operations as the volume of results grew daily and tracking needs changed with these expansions. 

Fortunately, public health measures were successful in Colorado, and the Rocky Mountain Regional VA Medical Center is currently transitioning into the normal operations phase of its COVID-19 response. The drive-through closed last Wednesday but nine members remain “on-call” for a Mobile Testing Team to remain available. The day following closure of the drive-thru, the team was able to respond to VACO-mandated surveillance to test 80 staff in the Spinal Cord Injury Unit. Members of the Colorado Springs team were able to do the same type of surveillance for the CLC in Pueblo, CO. The reach extended from Veterans in the community to staff to nearly every unit in the hospital, outpatient clinics and even our long-term care facilities.

This rapid response was possible because of a healthy clinical and research partnership consistently supported by local clinical and operational hospital leadership teams. 

Cari Levy, MD, PhD

Associate Director, HSR&Ds Center of Innovation for Veteran-Centered and Value-Driven Care

Co-Principal Investigator, Long-Term Care QUERI Program

Cari.Levy@va.gov

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