The Covid-19 pandemic has proven to be an unprecedented public health event globally. So many patient advocates and healthcare workers are dealing with so many unusual and "first time" clinical management issues. The usual "playbook" of clinical management and navigation of patient care has been changed and altered almost hourly as the pandemic moves through the U.S.
Issues such as critical care management, including when to place a patient on a ventilator and what medications should be used for treatment have been developed on an “as-needed basis”. As with any new disease, treatments are being developed as the needs arise. To say that healthcare workers must be resourceful is an understatement.
As nurse patient advocates, the challenges we faced at Healthlink Advocates (HLA) were more community-based issues, such as how to get our clients to their procedures and appointments safely and where and how to get our clients tested for Covid-19, if needed.
Just as our colleagues in the “field” on the acute care side were challenged and needed to “think on their feet”, we at HLA were also creating processes as the needs presented.
What did we do first?
Early on in the pandemic, when we noted the numbers in the NY and NJ areas were rising significantly, we decided to have a strategy to have clients tested, if needed. Many of our clients fall into the Centers for Disease Control (CDC) high-risk categories for Covid-19. This included clients who were over 65, clients who had co-existing medical conditions, such as heart disease, diabetes and immunosuppression and elderly clients who live in long term care facilities (LTCs) or assisted living (AL) facilities.
One of the first actions we took was contacting our clients and reviewing the signs and symptoms of Covid-19 and when they should consider testing based on symptoms. This included:
A fever greater than 100.4F
Coughing
Shortness of breath
The decision to be tested would be made in conjunction with the patient’s primary care physician (PCP).
The next step we took was to contact the PCP’s of our clients to discuss their process for testing. Most PCP’s were not testing in the office and directing clients to either hospital based drive-through testing centers or county run testing centers. It was important to share this information with clients, since many lived alone and would need to know what site to choose. In both cases, clients would need to bring their insurance cards, a form of state identification, such as a driver's license to show state and county residency and a prescription for the test.
An advantage of sending clients to a hospital-based testing center was that the physician’s office could fax the prescription to the testing site ahead of time. An appointment was necessary for both a hospital-based and county testing site. Another advantage of coordinating with the client’s PCP was to avoid sending our vulnerable clients to an over-crowded hospital emergency room, which was over- run with Covid-19 patients.
Some of the challenges we faced early on in the pandemic with getting a patient Covid-19 tested were the availability of testing kits, the lack of testing sites and the long turn around time for test results. However, these issues have improved significantly today.
Key Takeaways:
Although Covid-19 testing has become much more accessible today, here are some key takeaways to remember when seeking testing for Covid-19:
Be familiar with the PCPs process for testing their patients. Call the PCP ahead of time, before the patient has symptoms and needs testing.
Be familiar with where the testing sites are located. Check your state department of health and hospital websites.
Be familiar with the turn around times of the testing sites; county and hospital-based testing sites have a 48-72hr. turnaround time. Federal testing sites can have a 3-5 day turn-around time for test results.
Be familiar with how the test results will be reported. Both hospital-based sites and county sites will call the patient on the phone number documented on their registration form. They will not leave a message on the phone.
Be familiar with the CDC guidelines for testing and what the patient and family should do if the test is positive. Positive patients are directed to self-isolate until they are fever-free for 72 hrs. off fever-reducing medication. Their symptoms need to have improved and 7 days passed since their first symptoms. To learn more about the CDC Home Guidelines click the button below.