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All Hands on Deck
Drive-through COVID-19 testing takes 'huge team effort' from Emory staff

Emory nurse practitioner Hanheui “Honey” Bunting and physician assistant Meredith Ingram are among the staff who have volunteered to provide drive-through COVID-19 testing.

Emory nurse practitioner Hanheui “Honey” Bunting has a narrative for everyone who drives up to be swabbed by her at Emory’s COVID-19 drive-through testing site at Executive Park.

“I try to ease their anxiety,” she says. “I’ll say, “Hey, while I’m doing the swab, you can tilt your head back against the headrest and hold on to your steering wheel and not onto me! They tend to laugh. Then I’ll say, ‘This is not the most comfortable test but it takes less than 10 seconds. I promise to be quick.’ And I go get their testing kit.”

Bunting is usually the family nurse practitioner at Emory Clinic at Delta HQ, taking care of Delta Air Lines employees, but she was able to volunteer to work at Emory’s drive-through testing site from its opening on April 9. 

“I’ve been here from Day 1,” Bunting says. “It’s been a wonderful experience, to say the least. There are multiple supportive staff there to ensure our safety and efficiency. The culture really promotes safety first and being able to talk about things and communicate any concerns.”

Fellow provider Meredith Ingram, a physician assistant who works in the Department of Otolaryngology at Emory Clinic, says she is used to performing nasal endoscopies, so the swabbing doesn’t faze her. She likes being hands-on and also volunteers on the COVID-19 mobile “SWAT” testing team that goes into potential hotspots. “We tested 125 people in one day at a nursing home,” she says. “At the drive-through site, we’ve seen 100 on some days, less on others.” 

“I have always felt safe,” says Ingram, of the staff’s personal protective equipment (PPE) and infectious disease protocols. “We are basically in hazmat suits. I feel safer here than going to the grocery store.”

One reason for that is the training and support of Heidi Wells, an Emory Brain Health Center nurse educator who has been maintaining PPE inventory for the drive-through testing site and training the providers in PPE donning and doffing and proper infectious disease protocol.

“Our providers wear protective suits and a PAPR, which is a helmet and air purification system with a battery pack that blows air, and a shroud/hood attached to the helmet. There is a tie that seals everything around the provider’s neck, so it’s a closed system.”

Providers are double-gloved. “The first set is thicker and comes up high on the wrist, and testers act as though those gloves are their bare hands. Then they wear a regular pair of exam gloves over those that they change after each specimen collection,” Wells explains. The providers “hand sanitize” their first set of gloves and wipe their suit down after each patient. They also wear “booties” that cover their shoes.

The result is high-level protection for provider, staff and patient, Wells says: “Some of this PPE equipment was left over from Ebola, so we are being really good stewards of what we have.”

Testing is by appointment only. Many patients are referred to the testing site after calling Emory Healthcare, concerned that they have the virus. Emory Healthcare also has started pre-screening patients for COVID-19 who are scheduled for surgery at Emory hospitals.

“We are pleased to offer this drive-through COVID testing site to our patients, staff and the general public,” says Penny Castellano, chief medical officer and associate director of Emory Clinic. “Patients are conveniently tested in their cars and usually receive results quickly via a phone call.”

‘A huge team effort’ 

Those staffing the testing station, says Castellano, are by and large volunteer provider and clinical staff. “This has been a huge team effort,” she says, also crediting infectious disease physician Marybeth Sexton and senior nurse manager Mindi Cody for overseeing logistical and technical challenges. “It was astounding, the speed at which all of this came together.”

Deena Gilland, chief nursing officer for Emory ambulatory patient services, says the amount of planning and details involved in establishing the site quickly was impressive.

“We had staff from facilities management, IT and IS, lab techs, supply chain, security and clinical. Without the support team, this would not have been possible. It was a yeoman’s lift to get it up and running, and that happened because of the team’s commitment,” she says. “It’s a stressful situation, but everyone is taking it on with grace and ease, making patients feel comfortable. It’s fulfilling for them, as well, in the midst of crisis, to know they are making a difference.”

As project lead, Ariona Day, a senior operations business manager at Emory Healthcare, oversaw much of the planning and execution, from process flow to electronic medical records. “We all feel an overwhelming sense of gratitude for an opportunity to serve our community during this once-in-a-lifetime health care crisis,” Day says. 

Emory’s TravelWell Center was one of the first Emory sites to do COVID-19 testing, says center director and infectious disease physician Henry Wu, which was then expanded to a Wesley Woods walk-in testing site and the Executive Park drive-through. “This is obviously a totally new phenomenon, drive-through testing for a highly prevalent, highly infectious disease, which entails doing high-volume testing with all the accompanying infection control issues,” Wu says.

When helping to set up Emory’s site, Wu reviewed any available information about drive-through COVID-19 testing sites in South Korea and the University of Washington, while adapting the methods to “fit our needs, location, PPE, etc.” He also observed the workflow of a drive-through testing site in Fulton County.

“Obviously a huge concern is infection control for providers who are doing swabbing, and handling specimens, but also for the patients, the majority of whom may not have COVID-19,” he says. “Even if they stay in the car, we’re interacting with them. How do you test a high volume of patients safely?” 

Then there is the technical aspect of collecting a swab. “You want a good specimen, but you’re not collecting under ideal circumstances,” Wu says “We are all trained to take specimens from patients sitting on exam tables. I had to pull a bit of experience from my previous job, as a medical epidemiologist in the CDC’s meningitis branch, when we collected throat swabs during outbreaks in college settings or the basement of bars … these are the kinds of in-the-field things that are done in public health.”

The result, he says, has been a safe, efficient site collecting good specimens. These specimens are packed individually, picked up regularly and taken to Emory labs, which speeds up the process. “It’s all done in house now,” Wu says. “Fortunately, our labs developed their own assay, which has the capacity to test large numbers.”

‘We’re all in this together’

The providers performing the testing say it’s been a privilege.

“Everyone you test is so grateful,” says Ingram. “For many, it’s their only time getting out of the house. One patient was so sweet, I asked for their name and date of birth and they started crying. It makes you feel closer to humanity. Selfishly, I’ve enjoyed it, as an avenue to relate to people. Our slogan of ‘We’re all in this together’ has never been more appropriate.” 

Bunting adds, “It has been a great opportunity, to experience this. To be able to provide this service, in the thick of it all, I actually feel lucky. Fifty years down the road, I’m going to ask my grandchildren, ‘You know what I did during the pandemic?’”

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