Goal – to screen and properly identify at risk patients for COVID-19 in an open-air environment that minimizes risk of cross transmission to patient/staff. Test site uses NP aspiration as specimen collection method which maximizes the sensitivity compared to NP swab. The ultimate goal is to detect if a patient has COVID-19 and minimize the risk of a false negative result. 

OUTSIDE SETUP

1. Staff will be trained for no touch interaction and process
2. Site outside of clinic and will be established with outdoor open air tent and low level exam table, specimen mayo stand separate from clean mayo stand.
3. 3 parking spaces will be designated for testing patient, on-deck patient(next up) and in the hole patient(3^rd in line- new arrival). Transferable signage in front of 3 sites.

INTERNAL INFRASTRUCTURE

1. All updated and proper PPE for staff will be adhered to and dependent on role and contact of patient and/or specimen.  It is understood this may change dependent on new advisements and available PPE.
2. Lab specimen computer/EMR computer with label maker established for this purpose inside for runners.
3. 7-minute time slots established in schedule for appointment times.

TESTING PROTOCOL

1. Screening and testing protocol
   1. Patient calls CLINIC and patient is screened by CDC and Dept of Health guidelines to establish candidacy for testing. If patient meets criteria then patient's information, insurance, contact information obtained and placed in EMR system and patient is given appointment and instructions as follows:
      1. Patients will be given instructions of visit by text and/or email in addition to verbally when making appointment.
      2. Patients are instructed to wear appropriate coat, in addition to gloves and mask.  If they do not have a medical mask, a ski mask or scarf covering their mouth and nose is allowed.  No one in patient’s car is allowed to leave the car other than patient at instructed time by test site worker.  Patient should bring ID verification and insurance card.
      3. Patient is mandated to drive in their own car and to arrive into parking lot 15 min prior to testing time.  No sooner and no later or their test will be cancelled.  They are not allowed to park in street or line prior to this. They will arrive and look for test site banners and park in the “In the hole -ARRIVAL” designated parking spot.
      4. “In the Hole” screening.  Patient will crack window for communication.  Employee with proper PPE will greet and review process by employee and verify patients’ mask and gloves. Employee will verify patients name for test appointment in 15 min. No contact will be made between Employee and patient at any time.
      5. “On Deck” car will be approached by employee and patient displays documents in window. Picture will be taken of patient's ID, insurance card, and put directly into EMR.
      6. When patient’s car is designated as testing spot the patient will be signaled to exit their car (no others may exit with patient). Patient will walk up to testing tent as instructed by employee. If patient needs wheelchair or assistance to test tent this will be provided by protected employee. (Request for need of assistance will be discussed at time of booking appointment)
      7. Patient walks to testing tent, greeted with name confirmed by specimen collector and lab runner.  Patient label placed on syringe prior to aspiration.  Patient instructed to lie on back with head at end of table without touching table. Patient's coat, gloves and mask to remain in place. Patient asked if they have difficulty breathing out of one nostril more than the other.  Specimen collection as described below:
         1. Mask pulled down to expose the nose but mouth still covered to catch any potential cough or sneeze during the process for NP specimen.
         2. A nasopharyngeal aspirate is obtained on side patient most open nostril. Patients head extended with chin up and catheter inserted with verified depth of catheter, instillation and withdraw of aspirate and at least 1cc of aspirate obtained. Patients mask replaced. 
         3. Syringe capped and aspirate catheter disposed of in contaminated receptacle. Capped labeled specimen syringe is placed in specimen bag held open by Lab runner. 
         4. Lab runner confirms labels and paperwork and  verifies name on labels with patient.
         5. Patient asked if any further questions and verifies posttest instructions and recommendations for isolation. Written handout can be delivered.
         6. Specimen processed per lab protocol.
         7. Although minimal contact other than gloves for personnel, PPE should be changed for each staff member appropriately based on exposure risk/role in process with proper donning/doffing.
         8. Employee will move the three signs for 3 cars parked as each test patient leaves. Thus when “test” patient leaves…. portable sign for “In the hole” moved to this spot, In The hole sign replaced with On Deck, and On Deck sign replaced to Testing Spot.
2. Processing, Documentation and Reporting of results to patient and State Health Dept per protocol.