Clinical laboratories were quickly overwhelmed by increased demand as COVID-19 swept the U.S., leading public health departments and private labs to suffer long delays in returning results.
Several hospitals decided to rely on their own in-house labs to expedite the process, and those decisions came with their own growing pains.
Providers told Modern Healthcare what they learned about scaling up capacity and maintaining a successful testing lab operation amid the pandemic.
1. Be flexible with lab protocols and staff
At the start of the pandemic, many hospital labs were forced to develop their own COVID-19 tests as the Centers for Disease Control and Prevention faced delays rolling out the first approved test.
Dr. Karen Kaul, chairwoman of the department of pathology and laboratory medicine at NorthShore University HealthSystem in Evanston, Ill., said a lot of the initial work was done "on the fly" as they cross-trained lab personnel to support molecular lab staff as they scaled up capacity.
Being nimble was key to making the transition work, Kaul said. While molecular lab technicians did the more difficult aspects of developing the tests, other staff helped with sample preparation and clerical tasks.
"Redefining roles quickly made an enormous difference in keeping some people who were being underutilized busy and also allowing our staff to get the work out," she said.
2. Diversify testing platforms to address supply chain challenges
Labs have seen shortages of testing materials including reagents, swabs, kits and chemicals as COVID-19 testing fails to slow down. Hospital labs normally seek to use a single testing method or platform to get a unified set of results.
But that rigidity would force many hospital labs to shut down if they can't get the materials they need. To address potential shortages, some providers have been using several different COVID-19 testing platforms and switching methods when they run low on some materials.
CommonSpirit Health chose three different testing platforms from three different vendors to avoid shortages or issues if one system failed, according to Karen Smith, vice president of laboratory services.
The health system got its vendors to commit to providing certain volumes of tests so they couldcomplete10,000 tests per day, Smith said.
"There are vendor limitations, and I didn't want to put all my eggs in one basket," Smith said.
3. Maintain a quick test result turnaround time
Material shortages aside, hospitals and individuals have experienced delays in receiving test results. While turnaround times started at three or four days, they have crept to a week or more as labs had difficulty expanding quickly enough to meet demand.
The slow return rendered some coronavirus tests useless as diagnostic tools, since some asymptomatic patients would leave isolation earlier than recommended and potentially spread the virus.
By contrast, hospital labs have generally been able to process and get admitted patients their results within 24 hours.
NorthShore's average turnaround has been a couple days even when they processed up to 1,800 tests per day. Establishing a centralized testing system helped maintain efficiency, according to Kaul.
The health system also developed smaller capacity testing instruments at each of its hospitals for situations where they need quicker test results, such as for psychiatric patients in the emergency department or for those being admitted for high-risk medical procedures.
"Having both the large throughput testing and the small number of tests that need to be turned around very quickly is really ideal," Kaul said.
4. Establish stronger collaborations between laboratory, clinical and administrative personnel
Six months of COVID-19 has reminded hospitals they need strong, in-house laboratory capacity to maintain patient care, Kaul said. The labs provide up to 70% of the data in a patient's electronic health record.
"We're so behind the scenes that we're often forgotten unless there's a problem," she said.
Since that start of the pandemic, NorthShore has held frequent multidisciplinary team discussions on how to deploy new tests.
The key to a successful testing lab is providing ongoing, predictable testing that staff can rely on, according to Dr. Dwayne Breining, executive director for Northwell Health Labs. In March, Northwell Health was one of the first systems in the country to begin mass COVID-19 testing of its patients. It scaled up capacity within a month, from completing 100 tests to more than 1,000 a day.
Hospital labs should have clear, expected goals supported by leadership, according to Smith. CommonSpirit recently opened a new laboratory hub in Arizona that Smith said will triple the health system's capacity to process COVID-19 tests. The new facility will ultimately focus on precision medicine after the pandemic lapses.
"We made the decision that was a long-term strategy for CommonSpirit Health that just got moved up by a few years," Smith said.
