A Testing Site With No Lines - Learn How the Whatcom County Health Department Became a Model for Others to Follow

At first glance, the Whatcom County Health Department’s drive-through COVID-19 testing site in Lynden, Washington, looks just like all the other testing sites set up all across the country. But take a closer look, and you’ll soon see that this site, located at the Northwest Washington Fairgrounds, is different from all the others. 

This site has no lines, and it’s been that way since August. 

“It’s so mathematically perfect, we see four people every three minutes and at the end of the six-hour shift, we’re done,” said Lynn Pittsinger, a Supervisor for the Whatcom County Health Department. “The most we’ve tested in six hours is 630 patients, and in general we see between 480 and 500 patients per day.”

Pittsinger is one of two site supervisors leading the community testing program at the Fairgrounds.

“We recently moved there and the patients moved with us,” she said. “We do two three-hour shifts five days a week. We’re currently testing between 2,500 and 3,000 patients every five days.”

Pittsinger, who is fast-approaching her second anniversary with the Whatcom County Health Department, has used her extensive background of working with emergency departments and implementing systems to mobilize and train a testing team made up of no more than seven staffers on any given day.

So how is such a smaller team able to handle the site’s current testing capacity while providing patients with such a smooth and stress-free experience?

According to Pittsinger, the keys are a well-oiled team, an excellent laboratory testing partner in Northwest Laboratory from nearby Bellingham, Washington, and a system centered around the TestDirectly Direct-to-Consumer Portal. 

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The Early Days

“When I tell people what we’re doing and what we’re seeing, they’re amazed,” said Pittsinger. “When we first started, if we did a couple of hundred cases a day, we were exhausted and proud of ourselves for what we accomplished. Now, when we have a day with 400 patients, we say we could’ve done 200 more.”

Back in July, the Whatcom County Council asked Pittsinger to implement a drive-through testing site and to get it up and running in a week. She quickly prepared and presented two options to the council, going into detail on what would be needed for each option. 

“We can do it with an automated and pre-scheduled system through TestDirectly at a lot less cost, or we can go in the other direction,” said Pittsinger, recalling that day. “I laid out what it was going to take in terms of time and resources, and the council decided on the other option.” 

The other option was a paper-dominated system similar to one being used by a neighboring county. 

Pittsinger followed the council’s recommendation and opened the Whatcom County Health Department testing site with a paper system.

“We did four days over two weekends of testing without appointments where the patients could just show up,” said Pittsinger. “We would do 280-to-300 tests over a full day with 30-to-50 people for staffing. We had long lines and three-hour waits were not atypical.”

After the fourth day, the council agreed to give TestDirectly a try.

Soon thereafter Pittsinger and the TestDirectly team began the implementation process.

“The TestDirectly team was amazing and accommodating,” she said. “I felt bad at times because there were cases when I was communicating with the team at three in the morning, but together we made a system where folks could schedule a test with TestDirectly online, and we as a health department could identify outbreaks and get on them quickly.” 

After trying a couple of variations and testing a few different scenarios, Pittsinger said the site had an unadvertised soft opening in a county-owned parking lot about a block away from her health department. There were only small numbers the first week, and this allowed her team to keep refining the process. 

By August, the current system was in place and running smoothly, and it didn’t take long for others to notice.

Soon site supervisors from nearby counties were coming out to Lynden to observe her team in action because they can’t comprehend how it was possible to run a site so efficiently with such a small staff. 

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The System

The Fairgrounds drive-through in Lynden is available for both insured and uninsured patients. All patients are asked to pre-register and schedule their tests through the TestDirectly portal. Testing is also available for pre-registered walkers and bicyclists.

The test site supervisor, equipped with two computers and two zebra printers, monitors traffic, infection control, and the labeling of specimens, making sure that they maintain integrity and that they are married to the right orders. The supervisor also manages three-to-four testers and one-to-two check-in assistants, with the number of testers and check-in assistants fluctuating based on the expected volume for that day. 

Patients in vehicles are ushered into two lanes upon arrival. The testers greet each patient and ask if they’ve pre-registered. If yes, the site supervisor confirms the name and prints a label from the TestDirectly portal. The printed label goes on the specimen vial. At the same time, a key code is also printed, placed on a handout, and given to the patient. The handout includes details for how the patient can access his or her test results. 

Next, the patient is swabbed. The specimen is then placed in a clean bag and sent over to the check-in assistant, who physically checks in the specimen and keeps a running total. At the end of the shift, the site supervisor compares the check-in list with the actual count, and if the list matches the count, the orders are electronically sent through the TestDirectly portal to Northwest Laboratory and the specimens are shipped to the lab. 

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If for some reason a patient doesn’t appear in the system, Pittsinger said the site has designated special spaces that the vehicle can move up into without holding up the line. She said in cases like this, check-in assistants help with registration and a tester is sent to the vehicle after registration. 

Going beyond the on-site staff, Pittsinger said that two test access schedulers remain back at the health department to answer phones and take questions. She said the schedulers fill the gaps for people without access to the internet or an email address, and who can’t read or type in English. The schedulers assist with the scheduling of a test, and they are also trained to give results. 

Patients are told to expect their test results within 24-to-72 hours of specimen collection but in most cases, Northwest Laboratory is providing results well within 24 hours. As soon as the test results are ready, the patient is automatically notified by TestDirectly to check his or her results in the portal. 

“The resulting. That’s a huge thing, and with Northwest Laboratory, we’re often getting results back within 18 hours which is phenomenal,” said Pittsinger, who also noted that her health department can track the testing numbers in real-time.

“At the end of every day, the site supervisor writes a report, and that report lists any issues that we had and our numbers for the past five days,” she said. “How many tests we’ve done, how many are pending, and how many are positive. We have a health information group in the background that has administrative rights to TestDirectly and they can create reports and identify outbreaks from that data.”

With TestDirectly, Pittsinger can also make adjustments to the flow at any time, another major advantage that allows her team to push capacity without sacrificing the patient experience.

“We’ve used the system enough to know just what we need to do to make things flow,” she said. “If I need to ramp it up I can increase our volume of scheduled appointments in real-time, and then I just know how to adjust our staffing to accommodate the increased volume so that flow never stops. There’s no wait time. The most anyone might wait is 10 minutes and that’s usually when the first patients of the day show up early thinking that there will be a long wait.”

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COVID Outbreak Testing

Now that the Fairground testing site is in a stable place, Pittsinger and her team have initiated an outbreak testing program for vulnerable populations in their community. To accomplish this, they’ve implemented a system where one tester and four check-in assistants take TestDirectly on the road with them, moving through the city in a van to service those who are experiencing homelessness. 

“When we’re using TestDirectly, we can get those results back very quickly,” explained Pittsinger. “We have mobility, back-up power, and MiFi (wireless hotspot) to manage this, even if we’re in a setting that doesn’t have all the features we need.”

“We sign folks up on-site with TestDirectly, and we have a prioritized 18-hour turnaround time with Northwest Laboratory that enables us to contain the virus,” said Pittsinger. “We just finished a round of tests with zero positives. That means we’re staying on top of the virus with a team response. To know that we can do this is very reassuring.”

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The Future

“When the vaccine started traveling around the country, I got tears in my eyes,” said Pittsinger, while reflecting on the past several months. “ I’m very hopeful, but I also know that COVID testing for our county has been an absolute Godsend. We can get real numbers in real-time and we have folks that are ready to attack those numbers and keep our community safe.”

Pittsinger said it’s been a true team effort with everyone pulling together on a common cause.

“I can’t say enough about the TestDirectly team and Northwest Laboratory,” she said. “If there was something that could be done, they were making it happen. They’ve been definite partners in this process. Also, none of this would’ve been possible without the support of our volunteer staff and the Whatcom Unified Command.”

“I have a daughter in Florida that recently had to wait in line for three hours to get a COVID test, but it doesn’t have to be that way,” concluded Pittsinger. “If I were approached by another government agency, I would tell them they need to look at TestDirectly, and I would be happy to help anybody get started.”

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