Health Services is fighting against the COVID-19 pandemic. While the Medical Centers care for the very ill patients affected by COVID-19, the Ambulatory Care Network (ACN) has taken on a key role in community volume testing for Coronavirus. Martin Luther King Jr. Outpatient Center, Edward R. Roybal Comprehensive Health Center, H. Claude Hudson Comprehensive Health Center and Bellflower Health Center are supporting, large-scale, high volume, LA City testing. El Monte Comprehensive Health Center, High Desert Regional Health Center, Hubert H. Humphrey Comprehensive Health Center, Lake Los Angeles Health Center, La Puente Health Center, Wilmington Heath Center, Mid-Valley Comprehensive Health Center (CHC) and Glendale Health Center (HC) of the San Fernando Valley Health Center Group (SFVHCG) all answered the call to provide ACN based testing in key areas.

SFVHCG developed an integrated model for robust testing of Health Services patients and community members at Mid-Valley CHC and Glendale HC, dramatically increasing COVID-19 testing capacity over a short period of time. Mid-Valley CHC went from seeing 67 patients in April to 1,456 in July, testing a total of 1,908 patients between April and July. Glendale HC went live on August 17, 2020, and despite very limited space, capacity, and staffing, is testing over 20 patients a day.

Both sites are proud to maintain a five-minute cycle time for patients, thanks to many workflow changes and countless trial-and- error attempts to refine the process. The groundwork for drive-through testing at Mid-Valley CHC was adapted from Dignity Glendale Memorial Hospital’s drive-through model. Lessons learned from Mid-Valley CHC were then spread to Glendale HC. The teams faced rapidly changing recommendations and Expected Practices,  and quickly changing procedures (i.e., the way patients can schedule appointments, type of test kit, etc.) which required staff to move quickly and think out of the box. Some ideas that work well for SFVHCG testing sites:

• Using a rolodex to store all Health Services patient labels alphabetically, which makes it easy to find the correct label quickly.
• When it’s busy, using post-its to write down type of patient (i.e., Pre-Op, Health Services, or Fulgent) along with patient’s name, date of birth, and appointment time, and sticking it on the car’s windshield before they get to the registration station. This makes it easier for staff at the front to register/check-in – and in the case of Fulgent, activate – patients, and for staff in the swabbing station to confirm two forms of patient identification.
• Using VoIPs and walkie-talkies to communicate between stations and inside the clinics.
• Using grabbers to give patients handouts and collect specimen kits – an idea taken from Bellflower, thank you!
• Team huddles before and after each testing session to review the number of patients scheduled, test all equipment, determine roles and discuss what worked well and what did not that day.
• Having a workgroup comprised of representatives of each department meet weekly to discuss progress, troubleshoot any problem that came up or may come up, and explore ways to improve.

1^st stop at MVCHC – Identification, Check-in and Education. When patients first arrive, staff at the front check the patient’s identification and registration. Lab labels are placed on the windshield for Health Services patients. Fulgent lab kits are placed on the windshield of Community patients. All patients receive swabbing instructions, home isolation instructions, and either a LA Health Portal  card or Healthvana handout as instructions on getting results.

2^nd stop at MVCHC – Swab, Drop and Go. Patients are directed to one of two lanes. There, a nurse explains how to properly collect a specimen and what to do after they’re finished swabbing before handing them the collection kit. Health Services patients are instructed to hand back their kits to the nurse after they’re finished, while Fulgent patients are instructed to drop their specimen in a drop location before they exit.

Park and Swab Testing at GHC – Capacity for testing at Glendale HC is much smaller – only three cars can be seen at a time. In order to prevent back-up onto the street, patients are directed to park in one of the three spots. If all three spots are taken, patients are asked to drive around the block and come back in five minutes.

Once parked, staff walks up to the car to confirm registration and  two patient forms of ID. Once the patient is checked-in or activated, a nurse tag-teams to provide education and swabbing instructions. Like Mid-Valley, Health Services patients return their specimen to the nurse while Community patients drop theirs in a drop bin as they exit.

COVID-19 testing at SFVHCG has truly been a team effort – nursing, medicine, IT, health education, dental, facilities and PAC took on new, constantly-changing roles with grace and a sense of humor that made testing so successful.