CEO SUMMARY: To allow patients and physicians to order at-home specimen collections of the novel coronavirus, Northwell Labs trained its 12-member mobile phlebotomy service in the procedures needed to collect samples using nasopharyngeal (NP) swabs. Since training occurred in the second week of March, demand has increased steadily from one to two calls per day to five to 10 requests daily. Collecting COVID-19 specimens from patients at their residences helps limit exposure to the virus.
CLINICAL LABORATORIES OFFERING MOBILE PHLEBOTOMY SERVICES are now an important resource to increase testing for home-bound and nursing home patients to help slow the outbreak of the novel coronavirus.
Providers can order a mobile nasopharyngeal specimen collection for their patients so they can remain at home, reducing the possibility of spreading the pathogen by seeking a test from a doctor’s office, emergency room, or urgent care center. Knowing that waiting rooms present infection risks, physicians have been limiting office visits.
In response to these problems, Northwell Laboratories in Lake Success, N.Y., has adapted its mobile phlebotomy service, called LabFly, for patients who need testing for the novel coronavirus.
During the early stages of the COVID-19 outbreak, the lab team trained its 12-person staff of mobile phlebotomists to collect the specimens via nasopharyngeal (NP) swab for symptomatic patients who meet certain criteria, said Michael Eller, the lab’s Assistant Vice President of Business Development and Strategy.
When the service began during the week of March 9 to 13, the team got one to two calls for nasal swab collections per day, said Bryan Hemmings, Northwell’s Senior Director for phlebotomy. As of March 27, the team was fielding five to 10 calls each day, he said.
“Currently, we’re limiting the mobile specimen collection service to patients who meet defined criteria to be tested or those in a nursing home or other facility who have symptoms or who have a physician’s or health department referral,” Eller explained. The service operates on weekdays from 7 am to 5 pm and occasionally later into the evenings and sometimes on weekends if needed.
After the phlebotomist collects the specimen, the patients remain at home while the specimen is tested, reducing the risk of spreading the disease. The mobile specimen collection is one of two innovative strategies Northwell Labs has developed in response to the pandemic. The other strategy is a drive-through specimen-collection facility that Northwell and the New York State Department of Health opened March 13 in Westchester County, N.Y. (See “Drive-Up COVID-19 Test Site Launched in Three Days.”)
Since 2010, the lab has run a mobile phlebotomy service for nursing home and home-bound patients. Last year, Northwell expanded the service to all patients needing bloodwork by developing a mobile-phone app called LabFly that patients can use to schedule a blood collection at home or the office. For this service, Northwell charges each patient a fee of $19.99. Insurance usually pays for the testing. (See “COVID-19 Patient? Northwell Has Mobile Phlebotomy App,” TDR, March 9, 2020.)
“Because this staff for this service was already mobilized on the road, it was a perfect vehicle for getting patients’ COVID-19 swabs collected at home,” Eller commented.
Partnering with EMS
When the virus began to spread worldwide, Northwell Laboratories recognized the opportunity to have the LabFly mobile phlebotomy team learn to do NP swabs, Hemmings said. To train phlebotomists to do NP swabs, the lab team partnered with Northwell Health’s emergency medical service (EMS) unit. The EMS doctors and the lab’s pathologists instructed the phlebotomists and emergency medical technicians how to collect the specimens and how to use the personal protection equipment (PPE) in patients’ homes.
Learning how to don and doff PPE is an essential skill for medical professionals because doing so incorrectly can spread the virus. To protect the phlebotomists from being exposed to the new coronavirus while serving patients, the laboratory developed a protocol for the best time and place to put on the PPE mask, gown, and gloves. As news reports show, healthcare professionals seeking to remain free of COVID-19 need to know the proper procedure for using PPE, known informally as “bunny suits.”
“We also had EMS train the trainers so that we can add staff as demand and testing capacity increases,” Hemmings added.
One challenge Eller and Hemmings faced was establishing criteria for responding to requests for collecting virus specimens. “We set the policy to do at-home collections for patients who suspect they have the coronavirus on an as-needed basis,” Hemmings explained. “Due to limited testing capacity, we didn’t advertise the at-home service because we didn’t want to get overwhelmed with requests.”
Physician Referral Needed
To qualify for an at-home collection, the lab team decided that patients would need to be symptomatic or have a referral froma physician or from the state or a county department of health.“When patients or family membersrequest at-home specimen collections, we take steps to qualify them,” Hemmings said. “We want to know if the patient has seen a doctor or has symptoms.”
While patients who need a blood draw can use the LabFly mobile app to request and pay for a phlebotomist for a blood draw at home, patients cannot use the LabFly app for an NP specimen collection—at least not now, Hemmings and Eller said.
The app also allows the lab team to track phlebotomists’ locations throughout the workday. “That function makes it easy for us to send phlebotomists to do NP swabs if they’re close by when a physician requests it,” Hemmings said. This feature is important given that Northwell Health’s service area stretches from the eastern end of Long Island into the five boroughs of New York City and to the city’s northern suburbs in Westchester County.
Another problem for the lab team involved the logistics and timing of getting the specimens back to the lab. “We try to have a four-hour turnaround time, meaning from the time a patient or doctor requests a mobile specimen collection until the specimen arrives at the lab,” Hemmings reported.
“We do that by having phlebotomists drop specimens at the patient service centers we have in Queens and Long Island,” he added.
Few mobile phlebotomy companies are collecting patient specimens for testing for the novel coronavirus. One that is doing such mobile collections is VeniExpress, a company in San Diego that serves physician offices, home health agencies, and hospice providers.
VeniExpress is partnering with several local laboratories to service their patients who want or need to have their blood drawn or specimens professionally collected in their homes.
“As the coronavirus spreads throughout the United States, many people have legitimate concerns about leaving their homes, even for vital services such as blood draws,” the company explained.
On the other hand, Apex Laboratory, a company in Westchester County, Elmsford, N.Y., which offers a mobile phlebotomy service, would not collect specimens from patients who have been diagnosed with the COVID-19 illness or have any of the known symptoms, the company said on its website.
Patients with COVID-19
“Please notify Apex immediately if your patient tested positive for COVID-19 or is a person under investigation for the COVID-19 illness,” said the company. Also, Apex would not test a person who lives in a community where community-based transmission of coronavirus is occurring.
Apex would not collect from a person who tested positive for the virus and is under mandatory quarantine or has had the symptoms of a respiratory infection, such as a fever, cough, shortness of breath or sore throat and has had contact with someone with a confirmed or suspicious diagnosis of Coronavirus in the past 14 days, the company said.
For Home Visits, Lab Sets Process for Donning PPE
WHEN DEPLOYING PHLEBOTOMISTS TO DO NASOPHARYNGEAL (NP) SWABS, Northwell Health’s lab team needed to determine the best time and place to don the personal protective equipment (PPE) the specimen collectors need.
Northwell Lab’s mobile phlebotomists are trained to do NP swabs, and they use their personal cars to drive from one call to the next. At the start of each day, the phlebotomists collect the swabs, universal transport media, and the PPE they’ll need for each NP-swab collection. In that way, they can do phlebotomy calls as they usually do and collect with NP swabs if needed.
Bryan Hemmings, Northwell’s Senior Director for phlebotomy, recognized that having phlebotomists put on the PPE suits before going into a patient’s home could be problematic. Doing so could give away information about the patient’s health and draw unwanted attention to the patient and the phlebotomist.
“We don’t want people putting on the PPEs in the street,” Hemmings commented. “Doing that could get the neighbors worked up or frightened. Instead, when the phlebotomist arrives, we asked them to call the patient by phone. “Once the patient comes to the door and before the phlebotomist goes into the house, we ask them to put on the face mask,” he added. “Once they put the mask on, they step inside the house and then put on the gown and gloves.”
Contact Michael Eller at 516-286-3292 or firstname.lastname@example.org; Bryan Hemmings at 516-286-9983 or email@example.com.