Passing the test: Pathology Department teams help carry Michigan Medicine through pandemic
To say the Department of Pathology has faced an increased and unprecedented workload over the past year would be an understatement.
“It’s been overwhelming,” admitted Christine Kizer, M.T., senior medical technologist in the Clinical Microbiology Laboratory. “But it’s also been incredibly rewarding. We have provided hundreds of thousands of (COVID-19 PCR) test results in a timely manner since the start of the pandemic, and that’s keeping our patients, our colleagues and our community as safe as possible.”
So what goes into testing for COVID-19? And what else does the Pathology Department do to help the organization run smoothly on a daily basis?
The short answer is “a lot.” And, in honor of Medical Laboratory Professionals Week, here’s a brief snapshot of how pathology has been involved in the pandemic response.
In February and early March 2020, only the Centers for Disease Control and Prevention (CDC) had the ability to test for COVID-19 under emergency-use authorization.
“It was a new virus, so our organization wasn’t equipped to test for it like we were other sorts of infectious diseases,” said Michael Bachman, M.D., Ph.D., associate director of the Clinical Microbiology Laboratory. “But we knew that whenever the pandemic would end up spreading to Michigan, we were going to need to have that capability.”
So the department acquired the test that was being performed by the CDC and adapted it to their existing equipment within the clinical laboratories at the North Campus Research Complex. It was a collaborative effort involving testing personnel, lab managers, medical directors and other pathology team members.
“The bulk of the work was assessing whether the results of certain specimens would come back properly using the tools we already had available,” Bachman said. “That meant we had to bring in positive samples, test them and ensure that we got the same result.”
Like all new test validations performed by the clinical labs, bringing up COVID-19 testing was a rigorous process that had to meet the highest of standards. Once the testing was confirmed to be accurate, a fast ramp up began in earnest, because COVID-19 had permeated southeastern Michigan.
The numbers grow
On March 17, 2020, the microbiology lab received its first COVID-19 specimen to process. By the end of March, the lab had performed more than 2,700 tests.
“Those days were hectic,” Kizer said. “We were training our staff on how to perform the tests, answering questions from providers, interpreting results and finding physical space to store such a high volume of samples.”
And they were doing it all with new social distancing and PPE guidelines in place — to the point where the teams were divided into two separate groups who never interacted with one another in order to maintain safety.
The workload became so large that other Pathology Department staff members were called in to help. For instance, the oncology-focused Molecular Diagnostics Lab team joined the effort — even though the work fell outside their typical responsibilities.
“We mainly do 50 or so oncology tests per day and don’t normally run tests for infectious diseases,” said Jennifer Bergendahl, B.S., MT(ASCP), administrative manager of the Molecular Diagnostics Laboratory. “That meant we were learning new processes and meeting new regulations.”
By the time Michigan reached the height of the pandemic, the molecular diagnostics lab team by itself was carrying out 650 COVID-19 tests per day — not to mention thousands more being processed by other staff members.
And on the main medical campus, Core Laboratory and Point-of-Care lab teams eventually began providing rapid testing for both inpatients and emergency department patients — with the most recent of these tests producing results in approximately one hour.
“At first, other elective procedures were shut down, so we could focus almost exclusively on COVID-19 testing,” said Bachman. “But once the hospitals and health centers opened back up again, our workload became even greater.”
By November 2020, the number of COVID-19 diagnostic tests grew to between 10,000 and 13,000 per week, or between 1,600 to 2,100 per day during a 10-to-12-hour shift. This is not taking into account the COVID-19 serology testing done in the Clinical Chemistry Lab, nor all of the other non-COVID-19 testing the clinical labs perform daily.
“What strikes me the most is how our teams were able to perform all of this work without ever sacrificing quality, safety or turnaround times for our patients,” said Riccardo Valdez, M.D., director of clinical pathology. “That speaks to the efforts of our specimen processing team lab and med techs, and our administrative staff.”
A community service
Lab testing isn’t the only service offered by pathology that has helped in the pandemic response.
Phlebotomy is typically the first in-person interaction many patients will have with pathology. Throughout the pandemic, phlebotomy teams continued to provide critical blood collections, both for inpatient and outpatients. Ensuring the staff and patients remained safe during these interactions meant extra diligence for cleaning protocols, along with modification of collection spaces to ensure social distancing was maintained.
Lisa Neal, C.R.A., OCT-C, the Michigan Medicine morgue supervisor, said her team, which is led by pathologist Allecia Wilson, M.D., has been conducting autopsies and testing all decedents for COVID-19 since March 2020. If the decedent tested positive, a more limited autopsy in an isolation room was performed. If negative, the team would carry out a normal autopsy in enhanced PPE.
“Often, people wonder why we’re testing for COVID-19 even after a patient has passed,” Neal said. “To us, it’s simple: We’re testing for the community. If we know a patient’s COVID-19 status, it will provide peace of mind to their loved ones, and allow for contact tracing and other preventative measures to be put into motion.”
The novel coronavirus also generated significant academic interest among the clinical and basic science research community, and the clinical lab staff played a central role in providing specimens to COVID-19 research biorepositories. The availability of residual sample for research has and will continue to lead to a better understanding of COVID-19.
The importance of technology
While the clinical labs started with one COVID-19 diagnostic test, they have since validated and implemented six more for infection and five COVID-19 serologic tests. Tests to simultaneously check for influenza, respiratory syncytial virus and COVID-19, as well as methods for pooled testing and saliva testing, were also developed. All of these new COVID-19 tests were added on top of the 5-10 new assays developed during the year for other clinical lab testing needs.
All of these lab efforts would not have been possible without technology keeping up, including information technology.
“We had to build software that allows our team members to input results for new tests whenever they were developed,” said Eric Jedynak, administrative manager for pathology informatics.
Jedynak’s group worked to develop COVID-19 testing and blood product utilization dashboards so pathology leaders and others in the organization could keep track of data relevant to the pandemic impact and response.
‘We take pride in what we do’
In the end, the vast work being performed by pathology has made an impression both within and outside the department.
“Our leadership and administrative teams have worked hand-in-hand with other areas of the organization such as pharmacy, nursing and the emergency departments to procure samples and supplies and to ensure results are delivered as quickly as possible,” Valdez said. “Everyone here has stepped up in incredible ways.”
“If it weren’t for the efforts of our pathology teams, a lot of public health officials and colleagues would have to be guessing as to how to best handle the pandemic,” Kizer added. “So we take incredible pride in what we do — and that makes it easy for us to sleep at night.”
Medical Laboratory Professionals Week
Medical Laboratory Professionals Week (MLPW) is an annual celebration of medical laboratory professionals and pathologists that takes place the last full week of April each year. The week, now in its 44th year, recognizes the vital role of the laboratory in health care and patient advocacy, and provides the profession with a unique opportunity to increase understanding of and appreciation for clinical laboratory personnel.