Implementation Logistics What we used to do What

Implementation Logistics • What we used to do • What we did this year • How it turned out • What we would do different

TB Screenings • Of our about 3600 students, 2000 are mandated to have annual TB screening • ECSHC Immunization compliance is driven by the CDC recommendations for Health Care workers, Los Angeles County Hospital immunization requirements, Children’s Hospital of Los Angeles, as well as other facilities requirements for immunization compliance

PPD Parties • All TB screening done in the month of April • Each school had an assigned day and time for placement and reading • Remote placement and reading of PPD • Considerations for remote placement -Staff -Supplies -Time -Space

How did we do that? Staff needed: Placement – 1 Licensed staff, 1 medical assistant, 1 Support staff Reading- 1 Licensed staff, 1 support staff Time needed: Placement- 1 hour per class Reading- 1 hour per class Paperwork- 1 hour per class Supplies needed: Transported to site for each placement and reading

What the TB screening with the PPD test cost in 2009 -2010 academic year Medication Chest Xray Supplies INH Tx $120 $ 7, 500 $ 70 $ 117 person (x 5)

IGRA Time Line • March 2010: Offered to students at cost 15% • July 2010: CDC/MMWR updated guidelines on use of IGRA’s • Sept 2010: Student Insurance agreed to cover test at 90% with deductible waived • Sept 2010: Mandated for the following students: – History of +PPD – History of BCG vaccine – Born outside of United States

Which IGRA did we choose? • We chose T-Spot due to – Financial considerations – Availability of test – Availability of Service Representatives – Used by other campus of USC

How do we do this? More Supplies Shorten Nurse Visits Inform Students of change More Staff More Blood Draws More visits at SHC T-Spot Test Inform Dept. of change

Getting the word out • • • Blast emails to students Educate departments of policy change Work with departments to inform students Screening forms for TB screening test Article in our newsletter Flyers in the exam rooms and on campus

It’s April, now what? Shorten nurse visits from 15 -20 minute visits to 10 -minute visits Have these shortened appts from 10 am-2 pm everyday Hire temp medical assistant/phlebotomist to work from 10 am-2 pm for nurse visits only Improve flow process for nurse visits Train staff on new process

What about the PPD Parties • We still offered the PPD parties to the departments • Arrange staff lunches around the PPD party • Decrease clinicians appt. during PPD parties • All students completed screening form to identify those who need the IGRA test

What was our volume of tests?

What did the T-Spot cost us this year? Out of Pocket tests $7, 000 Increase staff $ 1, 560 INH Tx $117 person (x 10) Chest Xray $1, 705 Supplies $100

What did we not anticipate? • Increase time for lab processing • Increase time for staff to enter results of IGRA – No Lab Interface System with lab – Two systems for compliance tracking • Increase time for clinician involvement – Signing visit notes – Signing lab results – Emailing lab results

We also missed… • Who will contact student with the result • Increase time for staff to contact student with result • Increase paperwork time for staff • Short staff during PPD parties • Communication with the IGRA processing company for more boxes

Challenges • The T-Spot lab is in Boston – All test have to be complete by 3 pm to be ready for shipping by 4 pm • Bad weather can affect if samples get to the lab – Oxford Immunotec will be adding a site in Tennessee to decrease shipping time in January • Staff sick time/ vacation/ disability

More Challenges • Student and Departments confusion – Not sure if this test will be accepted by rotations • Students and staff not aware of policy change – Not all students read the emails or newsletters • Staff in clinic not use to that pace of work

The challenges continue • Decrease availability of clinician visits • Multiple tests to be done for Invalid or Borderline results

Remote IGRA testing trial PRO’s • Students appreciated having the choice • Had large turn out of students at one time • Decreased the amount of students in the SHC • Students educated on IGRA testing • Good Customer Service to students who are mandated to get the IGRA Con’s • Difficult transporting of equipment and supplies • Need more staff at event • Leaves clinic short staffed for a greater amount of time • Decreases amount of Primary Care visits available

What will we do different next year? • Give each school their own month to get the testing done • Build into schedule processing and paperwork time • Hire temp staff earlier for better training • Hire more temp staff for Remote PPD parties

We will also… • Coordinate with IGRA lab for more supplies • Inform students of IGRA testing and process at new student orientation • Remote IGRA testing? ? ?