August 28, 2020
For many cystic fibrosis (CF) patients and their families, the need to come to the hospital for routine throat swabs that look for any bacterial growth in the lungs during the COVID-19 pandemic can be daunting. To alleviate these concerns, avoid unnecessary entrance to the hospital, and eliminate potential delays in care, the CF Clinic team at Children’s Hospital at London Health Sciences Centre (LHSC), created a new drive-up model of care that allows CF patients to receive their throat swab at the curbside.
CF is a genetically inherited disease that primarily affects the lungs and the digestive system, which causes severe breathing problems and extreme difficulty digesting and absorbing adequate nutrients from food. As part of the ongoing disease management process, patients with CF return to the Children’s Hospital clinic for a throat swab every three months to detect the presence of CF-specific bacteria in the lungs at an early stage where a course of antibiotic-based treatment can be considered.
“We were concerned that fear and anxiety of having to come to the hospital for a throat swab while the pandemic is still ongoing could mean that some families might opt to delay their appointments when their child appears to be healthy,” says Jennifer Itterman, Paediatric Nurse Case Manager at Children’s Hospital at LHSC. “We had suggested the possibility that we could do drive-up swabs as a way to keep the families out of the hospital and maintain routine care in passing, and it was our clinical leadership that really liked the idea and helped us to safely bring the drive-up swab process to fruition.”
Today, appropriate clinic patients and their caregivers receive an email that contains directions on where to park, with pictures, as well as the telephone extension they will need to call when they arrive. Everyone in the car over the age of two is instructed to wear a mask, and families are advised to limit passengers in the vehicle to just the patient and caregiver if possible.
For younger children, parents are instructed to sit with their feet out of the car while holding their child facing out to allow for the swab to be completed. For older children that are more familiar with the throat swab and do not require additional soothing they don’t even need to exit the car.
“We work with each individual family to ensure their child is comfortable in the drive-up swab environment,” says Itterman. “We’ve tried as much as possible to recreate the experience they would typically have in the hospital in an outdoor setting. We don’t just follow our medical processes, we also include other practices like making sure we bring out a cooler with the post-procedure ‘reward’ popsicle that patients would typically get at a clinic visit, as that helps to bring a bit of comfort and normalcy to the drive-up process.”
Though each visit only takes about 10 minutes from start to finish, drive-up appointments are scheduled 30-minutes apart to allow appropriate time to send the swab to the lab and complete the proper infection control procedures, such as changing gowns, wiping down the cooler, etc. in between patients.
Itterman notes, “We’re really grateful to have the kind of leadership support that allows us to implement new and innovative ways of delivering patient-and-family-centred care. We know the drive-up option is having a positive impact on maintaining the health and quality of life for our young patients, and that is ultimately why we do what we do.”
The CF clinic at Children’s follows approximately 75 to 80 patients each year.