Pandemic Prompts Switch to Drive-Up Anticoagulation Testing

Livingston HealthCare, a critical access hospital in rural Park County, Montana, has switched to drive-up anticoagulation testing as part of a larger organizational strategy to stay ahead of the COVID-19 pandemic.

The service started March 23, said Pharmacy Manager Brian Galbreth. He said the idea came up during a brainstorming session on how to reduce the need for the clinic’s mostly elderly patients to enter the hospital.

“We really want to try and protect [them] from exposures if we can,” Galbreth said.

Montana is just starting to feel the effects of the COVID-19 pandemic. The state reported 108 COVID-19 cases through March 27, and Park County reported its first case today.

“We know it’s coming,” said Galbreth said.

The launch of the drive-up anticoagulation service required coordination among staff at the hospital’s anticoagulation clinic, registration desk, and laboratory.

“It took probably the better part of a week to get things going,” Galbreth said. “Everybody was on board and thought it was a really good idea.”

The clinic schedules patients during three-hour blocks Monday through Thursday, allotting 15 minutes per drive-up visit. Galbreth estimated that about 30 patients used the drive-up service to complete their bloodwork during the first week of operation.

The hospital also offers a drive-up service for COVID-19 diagnostic testing — likely the first such program in the state, according to a March 25 statement from Chief Medical Officer Scott Coleman. He stated that the hospital has provided drive-up diagnostic tests since March 13 for patients with active respiratory symptoms.

Galbreth said the drive-up COVID-19 diagnostic tests are performed in an ambulance bay that’s physically distant from the drive-up area for the anticoagulation clinic patients.

He said the initial plan for the drive-up anticoagulation service was to use a designated parking space near the main hospital entrance. But that quickly changed.

"After we set up this parking space, the next day we had a snowstorm,” Galbreth explained. Rather than risk having the person who collects the blood sample slip on the way to the parking spot, the team instead asked patients to pull up under an awning at the hospital entrance.

Patients are asked to remain in their vehicle and phone the registration desk to confirm their arrival and undergo screening for symptoms of COVID-19. After the patient is registered, a laboratory technician visits the vehicle to perform the fingerstick test.

Galbreth said each patient’s International Normalized Ratio test result is documented in the electronic medical record system and sent to the clinic’s anticoagulation pharmacist, who follows up with patients by phone.

The switch to drive-up testing has allowed that pharmacist to operate remotely full-time.

“She’s managing the clinic, scheduling the patients, doing the reminder calls and the follow-up visits, all of it, from home,” Galbreth said.

He also noted that the anticoagulation service, whether by phone or in person, is provided at no cost to patients. He described the service as a community benefit that offsets savings from participating in the federal 340B Prescription Drug Pricing Program.

Before starting the drive-up service, the clinic staff developed a telephone script and had pharmacy technicians call patients to let them know how the new process works and to set up their initial appointments.

The patients also get a call the day before the appointment to remind them about the new procedures.

“We actually had patients walking in, still, to register and then going back to their car,” Galbreth explained. “That day-before phone call to reiterate the messaging — stay in your car, call this number, and we’ll have somebody come out to you — has been a big key to success.”

Galbreth said that because the anticoagulation clinic has a fairly low caseload of about 10–12 patients per day, patients weren’t previously required to set up an appointment for their blood tests.

“We just let them walk in to get their lab tests,” he said. “We would get a call from the lab saying, ‘Hey, we’ve got a patient.’ We’d drop everything and run over and see them.”

The scheduling system is more efficient for the clinic staff, and he expects that to remain in place after the pandemic ends and face-to-face visits again become the norm.

But he said some patients may need to be convinced to resume the traditional appointments after the pandemic ends.

“They kind of like the curbside service,” he said.

For more information and free tools regarding the pandemic, including a recently released Assessment of Evidence for COVID-19-Related Treatments, visit ASHP’s COVID-19 Resource Center and the new COVID-19 Community at ASHP Connect.