6_Staffing

6. Staff required for OSCTC

Sample collection staff

Consideration

Sample collection requires a mix of clinical and administrative staff which may vary depending on the type of test administered.

Consider having a site manager to keep things organized.

Voices from the Field

“The drive-thru doesn't really require a lot of nursing staff. It does require some people to have knowledge to do the swabbing, but … [can be staffed] even if you're not a clinician but comfortable asking general screening questions…
“This person is strictly a managerial type person who can make sure that things are run and answer questions and get workers organized. One big thing that we found would be helpful at each of our sites is just the site manager.”
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Initial registration / screening staff

Consideration

Registration may be the most time-consuming process when considering staff time. 

Collecting the right information and communication preferences from the patient up front can help build efficiencies.

Voices from the Field

“The bottleneck is really at the registration, the testing itself is pretty fast… it is just registering, which takes most time.”
“I think the best you can get through a screening in about 10 minutes. You're doing pretty darn good.”
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Marketing / public education staff

Consideration

Staff charged with marketing and education are needed to ensure the public is aware of the OSCTC.

Voices from the Field

Customer inquiries staff

Consideration

A central communication platform can build efficiencies.

Voices from the Field

“We have like an internal process to handle any customer inquiries that may come in through like our 800-number.”

Staff who orders tests

Consideration

Standing orders may alleviate provider burden and improve access, particularly in areas that require testing of out-of-state residents or have high rates of medically underserved persons.

Consider the level of licensure needed to order a test. In some states, pharmacists can order tests.

Voices from the Field

“...in states that allow pharmacists to be providers … pharmacists could initiate that lab order after they performed screening of the patient on site.”

Staffing for patient notification of results

Consideration

Ensuring test results get back to patients can be labor intensive.

Voices from the Field

Public safety officials

Consideration

Police, EMS, and other public safety personnel can be helpful in managing aspects of your OSCTC.

Voices from the Field

“The Sheriff’s office volunteered their time to actually be there to make sure that equipment and the like stayed in place as expected and was not damaged or anything. So, it was a heavy lift.”
“...we needed to be able to control traffic and to the extent we have someone that was a little unruly we wanted to have that security as well.”
“We have our Fire Department present because we also needed to ensure that we had coverage paramedics in case we have people that come through the line and we need to escalate this person directly to the ED, so we wanted to make sure we have paramedics on the ground. Paramedics and EMTs.”
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Community members and volunteers

Consideration

Tap into volunteer networks to reduce costs and minimize staff burden, particularly for administrative tasks.

Furloughed clinical volunteers may no longer be available.

Medical schools, or others providing clinical education, may be a source of staff for OSCTCs.

Voices from the Field

“We needed volunteers to help with paperwork before, during and after people were tested… volunteer networks have been very, very, very nice to us and take care of a lot of the lift of the administrative issues. These are folks who are very well motivated and have some sort of expertise in administrative work and work that needs to be done and they can be easily trained.”
“Every day I would get 14 people that were willing to volunteer their time and the majority of them are either furloughed or laid off from their healthcare jobs and so they were able to dedicate a whole bunch of time to us in those early days to really get the bulk testing and just mass coverage that we needed to get testing done”
“…six weeks in we realize that we can’t keep asking the health system for volunteers which is what we were doing so we actually use some of the city’s CARES money to pay for [name] Medical College who was one of our initial volunteers to actually staff them all.”
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Licensure needed for sample collection

Consideration

Staffing with the lowest level of licensure can save money.

Different states have different requirements around required staff licensure.

The type of test administered can also impact staffing requirements.

Voices from the Field

“What kind of providers are required …we have lots of different sizes to fit different states and what state laws are required. So, that's been definitely a challenge in terms of setting this up”
“Another piece is for point-of-care on-site. There are scope of practice laws that vary by region. Can a pharmacist do it? Can a nurse practitioner do it? And so, we have to also look at the regulatory aspects of who can do it and our labor availability which is variable by state and so, sometimes we have to lean towards swab and send versus point-of-care because we are not able to from a regulatory standpoint.”
“We got a waiver from the governor [to use MAs vs RNs for sample collection] but if the governor decides not to waive it then … that would cost us more money, or we have to staff with RNs, not MAs, so we keep our eye on that legislation pretty closely because that would change your staffing model and make it much more expensive if he doesn't continue that.”
“A single RN on site can oversee the LVN’s and MA’s to do collection of non-nasopharyngeal swabs. It all goes back to modality of the testing… As the modalities have increased, you can make more and more use of MA’s and LVN’s which is at a lower cost.”
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Health center staff availability

Consideration

With many clinics back up to pre-COVID clinic volumes, and with additional staffing needs within clinics for screenings and cleaning, staff resource pools may no longer be able to support OSCTCs.

Testing sites need to transition to longer term staffing solutions, which may include hiring new staff.

Frequent changing of OSCTC staffing may result in reductions in quality and efficiency.

Voices from the Field

“We staffed a lot of nurses and a lot of techs at the drive-thru and then when that happened when we need those nurses back on inpatient unit. We then had a gap”
“We were really tightly staffed pre-COVID. … now the other piece that changed for our delivery system is, we have greeters at all the healthcare centers. So, not only are you taking people to work in the screening site, you are taking people that would normally be answering the phones, working with patients, stand at the front door and take temperatures and ask questions. Plus, the cleaning in the healthcare centers has become incredibly time-consuming so there are more people doing that. So, we have upped staff in that we have increased the volume of cleaning people that come to the site to help us with that in the evening and during the day.”
“...trying to stay FTE neutral has been very challenging, to find just consistent staffing dedicated to this work.”
“we are even considering having this be like a service line and having additional staff hired”
“We sort of pull staff in different places to see who’s available and I think in some ways that affects your quality control”
“It was like you were constantly retraining people. By having a smaller core group, they're extremely efficient. They are well trained. They know what they need to do. So, we do have a core group, but it comes out of our baseline staffing in the clinic. So, it is difficult right now, we don't always have enough people to answer the phone.”
“…we transitioned it to being staffed through medical-surgical nursing and that has allowed us to really standardize how it's done. We put a competency in place so that the nurses who are new to the process site are signed off on a competency to make sure that were doing it in a consistent manner”
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Using contractors

Consideration

Contracting out the staffing for OSCTCs in some cases may be cost effective and appropriate.

Contractors may also bring a fresh set of eyes to your OSCTC and identify some efficiencies.

Contracting with organizations that manage multiple aspects of COVID-19 testing, compared to contracting with multiple organizations managing distinct areas, may build efficiencies.

Voices from the Field

“Using a contractor at least gives us the opportunity to get something in place quickly.”
"This is an opportunity to have someone else look at it and see if they can do more with less people and if so, great."
“We're really excited to find some partners that are more comprehensively and holistically approaching testing for COVID…[NAME] takes care of all the scheduling; they take care of all the sort of physical environmental things that need to be done on site… they have community engagement managers who recruit people on the ground, and they deal with the data. So, after the test is completed, the lab processes the result, sends it to [NAME], [NAME] sends it to the dashboard so that we're not touching the data, we're not seeing the data. And this sort of seamless, less partners who are more, have more comprehensive offerings, you're right, is sort of the new 2.0 version of our testing…”
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