FAST TURNAROUND
TIME FOR SAMPLES
From the outset, the lab
has maintained a 24-hour
turnaround time for samples.
“The health department’s
initial turnaround time was
one to three days, but they got
backlogged really quickly and
that turned into five to seven
days,” says Dr. Dominguez. “In
the clinical realm, that timeline
isn’t useful because we’re
making decisions in real time
about patient placements and
use of protective equipment.”
Waiting days for results
would spend resources. A
perpetually fast turnaround
time was crucial, so they made
sure to build efficiencies into
their process.
“It’s about how many runs
you can do in a day,” he says.
“We had to repurpose some
instruments. We had to rethink
our workflow in the lab. We
had to retrain people and
reorganize shifts, even ask
part-time people to come in.
It was a new way of thinking
so we could run the assay
multiple times a day and get
results out as quickly as we
possibly could. Our team really
stepped up, and I’m so proud
of them.”
Diversifying their platform
portfolio was also key. In
other words, they acquired
additional assays so they could
run more samples and keep
operation steady if they ran
into a supply chain issue with
one of the platforms.
On March 26, they brought a
second platform online through
a company they’d already been
in contact with when they were
initially evaluating their LDT
options. It’s a smaller platform,
says Dr. Dominguez, running
about eight samples at once.
But it has a quicker turnaround
time, so they’re able to run it 24
hours a day.
On April 7, they brought a
third platform online. It’s a
higher throughput system,
running about 94 samples per.
But it has a longer turnaround
time, roughly six hours from
start to finish.
“That one is really useful for
the samples we’re getting from
other hospitals,” he says. “We
can batch those and run them
all once and do a couple of runs
a day if we need to.”
A week later, they added a
fourth platform.
TESTING CAPACITY
AND ITS IMPACT
ON CARE
As testing capacity increased,
it helped the hospital
enhance patient workflow so
providers could continue to
isolate and cohort patients
and then quickly move those
patients out of isolation when
appropriate.
There were ultimately three
phases of testing, each linked
to when the assays were
brought online.
Launch of the CDC assay
was the start of Phase 1. All
patients admitted to the
A Children’s Colorado lab technologist pipettes samples in preparation
for extraction of the nucleic acid.
hospital with respiratory
symptoms or a fever received
a respiratory pathogen panel,
or RPP. If that was negative,
the patient was flexed to
the SARS-COV-2 test. While
pending, that patient was a
person under investigation and
was cohorted on the hospital’s
9th floor.
“While the number of patients
coming in was still relatively
low, that strategy helped us
quickly rule out or isolate,”
says Dr. Dominguez, “which
meant we could reserve full
PPE — gowns, masks, face
shields — for those patients
who were flexed.”
As more patients came in that
fit the criteria, though, they
needed to morph the strategy.
In Phase 2, they started testing
everyone who had respiratory
symptoms, regardless of RPP
results, because coinfection
was an increasing concern.
“That raised the number of
tests, but as we had more
assays available, we could
maintain our turnaround time
and still efficiently manage
the flow of patients in and out
of the hospital. We kept them
off that special floor and
could get them out of those
special isolations sooner,
which further decreased our
use of PPE.”
On April 9, two days after
they launched the third assay,
Phase 3 went into effect.
Every single patient who is
admitted to the hospital, even
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