Behind the scenes: MUSC Health Pathology and Laboratory equip for the pandemic

Emma Vought
July 10, 2020
Covid-19 testing in laboratory
An employee at MUSC Health running a COVID-19 test. Photo by Sarah Pack

Alone we can do so little; together, we can do so much. Over the last several months, this phrase has become even more symbolic as the COVID-19 pandemic has significantly changed our world. With dedication and esprit de corps, we have seen individuals come together to help to meet the needs of both patients and the public. Likewise, experts in the Pathology and Laboratory Medicine Integrated Center of Clinical Excellence (ICCE) have come together to develop a system that has enabled MUSC Health to be the most extensive in-house COVID-19 testing provider in the Lowcountry.

The team includes about 400 employees – 100 between the Florence and Lancaster medical centers and 300 in the Charleston division – all assuming a variety of roles. The department’s laboratories have long offered comprehensive services that include basic core lab testing such as chemistry, hematology, urinalysis, microbiology and blood bank, and they also provide specialty testing for areas such as immunology, hematology, genomics, transplant, cryopreservation and pathology. But since the start of the pandemic, the team has taken on an important new role: analyzing the diagnostic PCR tests for COVID-19 and the serology tests to detect antibodies.

Pamela Murphy, Ph.D., system administrator for the Pathology and Laboratory Medicine ICCE at MUSC Health, has seen a lot of change during this time and has been delighted with their efforts.

“A major success was how quickly this was implemented – to get brand new testing, manage high capacity volume, keep up our quality standards and our turnaround times,” said Murphy.

The benefits of this in-house system are the expertise of a multidisciplinary team and the speed of results. The goal is to treat patients as quickly and effectively as possible.

As the number of coronavirus cases increases, so does the number of people needing to be tested. With this increase in volume comes expectations of convenient access to testing, quick turnaround times and, of course, safety and accuracy. The in-house team receives specimens from throughout South Carolina and beyond. Specimens are collected from multiple fixed and mobile sites around the state. They also receive samples from other hospitals and sites not equipped to run the tests.

“Around the time we started our PCR testing,” Murphy explained, “we were resulting about 300 to 500 a day, and now we are at about 850 to 1250 a day.” This increased workload is in addition to their typical output.

Because of the increase in PCR testing demand and additional safety requirements related to COVID-19, the team is having to revamp its workflow. "We are really having to work with our teams to think differently, so we've actually started creating what we call a 'COVID lab,' and all those COVID specimens are streamlined and processed by the same team."

In addition to Murphy, these efforts are being led by Steven Carroll, M.D., Ph.D., ICCE chief and chair for Pathology and Laboratory Medicine; Frederick Nolte, Ph.D., vice chair of clinical pathology; Julie Hirschhorn, Ph.D., associate director of molecular pathology; Scott Curry, M.D., assistant professor in the College of Medicine; Daniel Scheurer, M.D., chief quality officer for the MUSC Health System; Keisha Church, microbiology and molecular pathology lab manager; Karissa McShane, outreach and lab client services assistant manager; Lori Gauld, executive director of pathology and laboratory medicine ICCE, to develop unique solutions to the new challenges. They established a testing work group to discuss COVID-19 operations and initially met seven days a week. They have since shifted to meeting five days a week.

PCR testing is a sophisticated test that requires highly trained molecular pathology techs to run it, and there is only a limited number of those individuals. MUSC Health, however, has five on its core team, which has incorporated cross-training other care team members from other labs and new workflow procedures and acquired new equipment and expanded capabilities of current equipment.

“It's actually enabled our team, who have all had some sort of Lean Six Sigma training, to really put that training to the test – developing new processes," Lean Six Sigma is an organizational process improvement method.

All the changes have also meant an increase in staffing hours and machine run times. Murphy explained that the equipment they already had in-house usually only ran eight hours a day, Monday through Friday. Now they are running it 24/7.

Although the future regarding COVID-19 is unclear, the lab team has a plan. It will continue to ramp up efforts, increase equipment and testing capacities and collaborate to find solutions to this rapidly changing environment.

“I think pulling together an interdisciplinary team is essential. Really trying to keep your ear to the ground and stay ahead of what's coming," says Murphy.  "I think teamwork and trying to stay positive throughout is so important. We have an amazing team that's dedicated to patient care and each other."

About the Author

Emma Vought

Keywords: COVID-19