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Lessons learned from setting up point-of-care COVID-19 test sites

By Melanie Padgett Powers, writer

To increase COVID-19 testing capacity during the pandemic, health departments across the country set up temporary point-of-care testing sites. During a May 19 APHL 2021 Annual Conference session, “Pop-up Problems: Quality Assurance for Non-Traditional Testing Sites,” laboratory leaders shared their challenges and lessons learned when creating these sites.

On April 1, 2020, Wisconsin laboratories had the ability to perform 3,482 COVID-19 molecular tests in one day. By expanding capacity through temporary point-of-care testing sites, the state now has the ability to perform 59,273 tests per day.

Laying a foundation for success through partnerships

The City of Milwaukee Health Department worked with the Wisconsin Department of Health Services to rapidly scale up testing in Milwaukee using 15 of the portable Abbott ID Now COVID-19 analyzers. Milwaukee’s public health professionals set up sites in homeless shelters, correctional facilities, student health centers, a fire department and health clinics that provided care to vulnerable populations. Because COVID-19 test results could take about 15 minutes, some sites were provided with more than one analyzer to speed up testing, said Kristin Schieble, MLS, laboratory operations manager, City of Milwaukee Health Department.

“Each category of deployment site came with its own challenges,” Schieble said. “For sites that did not traditionally identify as a laboratory, finding dedicated staff to be able to manage the point-of-care testing while fulfilling all of their other day-to-day operations in a pandemic was difficult.”

In addition, at least half of the sites had limited space and did not have an ideal location to set up a temporary laboratory. However, “all the sites were able to rapidly mitigate the spread [of COVID-19] in a high-risk population or setting,” Schieble said.

Creating a point-of-care program

To build a successful point-of-care program, the Milwaukee public health laboratory focused its planning on four main areas: team selection, training, tools and outreach. It became clear early on that taking the time to plan upfront and establish a core team was critical to success, Schieble said.

“Outline the roles and responsibilities from the start so there are some efficiencies and people aren’t duplicating efforts and can really focus on their tasks at hand,” she said. “The team selection was really instrumental in ensuring a smooth and timely rollout.”

The core team was made up of the clinical services deputy commissioner, laboratory director, preparedness/testing coordinator, technical staff and Schieble as the laboratory operations manager.

When it came to training, the team realized it was critical to designate a “super user” at each site who would ensure all procedures were followed and would be readily available. At some sites, they had to impress upon their contact the importance of answering their emails and phone calls.

Consideration had to be given to who should be trained, what content would be presented, where trainings would take place, and how the training would be presented. Point-of-care laboratory operators may have no laboratory experience, so it is important to incorporate Clinical Laboratory Improvement Amendments (CLIA) regulations into the training safety protocols and guidance. “This included assisting sites in acquiring a [CLIA] certificate of waiver, if they needed one, or helping them navigate modifications to existing certificates,” Schieble said.

Attention was also given to what type of tools and resources would be used to ensure consistency across the sites. The Milwaukee department created standardized documents which included a training guide, quality control logs, competency assessment documentation, and a site survey to assess physical space and site capacity. All of the documents were developed to capture CLIA requirements.

The fourth component of the planning was outreach. Health department administration staff conducted pre-screening calls to gauge partner interest and begin selecting sites. After the pre-screen, each site completed a site assessment survey.

“Public health laboratories pride themselves on following the highest safety standards to keep our staff safe,” Schieble said. “So, when implementing a point-of-care test system in a non-traditional setting, it’s priceless to share this information or knowledge. It’s such a great opportunity to educate and advance safety practices in our community settings.”

Pictured: A scientist from the Milwaukee Department of Health Laboratory provides hands-on training to an operator at a non-traditional test site. (Photo provided by MDHL.)

APHL 2021 Annual Conference was held online May 4-20, 2021. View the final program and follow #APHL to join the conversation.

Melanie Padgett Powers is a freelance writer and editor specializing in health care and public health.

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