Examining the Adequacy of COVID Test Result Turnaround Time in SNFs

^{By Julie Gould} 

According to a research letter published online in JAMA Internal Medicine, only a small number of skilled nursing facilities (SNF) had less than a 1-day turnaround for staff or resident COVID-19 testing. Importantly, test result turnaround time nationally was 3 days or longer. 

“Surveillance testing is critical for controlling asymptomatic and presymptomatic viral transmission in these high-risk settings. For surveillance testing in SNFs to effectively guide infection control, results need to be obtained in less than 1 day,” the research team wrote. “Little is known about the adequacy of test result turnaround in SNFs.”  

To better understand why testing turnaround needs to be prioritized and improved on a national scale for nursing homes, we spoke with study author Michael L Barnett, MD, MS, assistant professor of Health Policy and Management at the Harvard T.H. Chan School of Public Health and primary care physician at Brigham and Women’s Hospital.

What existing data led you and your co-investigators to conduct this research? 

Nursing homes have been devastated by Covid-19 with over 40% of Covid-19 deaths nationally. One of the key tools to slow this devastation is with regular screening tests of nursing home staff, but little is known about how good (or bad) nursing home test turnaround is.  

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising?

In one of the first studies to report test turnaround time nationally, we used a new federal survey of nearly every nursing home in the country and find that only 14% of nursing homes get Covid-19 test results back in less than one day and 40% get results back in 3 days or longer (an unacceptably slow turnaround). We found the same pattern of testing turnaround even among homes in “hot spot” counties supplies with rapid testing machines from the federal government, which implies that these machines are not helping nursing homes with the rapid turnaround they need. Our results show that despite knowing about this vulnerability for a long time, nursing homes still lack the basic capacity to screen staff effectively to prevent new Covid-19 outbreaks as the country enters a new wave of infections. 

What are the possible real-world applications of these findings in clinical practice?

We need to prioritize improving testing turnaround on a national scale for nursing homes to prevent further decimation of this vulnerable population. 

Do you and your co-investigators intend to expand upon this research? 

Yes, we want to look at the impact of screening and test availability on nursing home outcomes. 

About Dr Barnett:

Michael L. Barnett, MD, MS is Assistant Professor of Health Policy and Management at the Harvard T.H. Chan School of Public Health and a primary care physician at Brigham and Women’s Hospital. Dr. Barnett received his MD from Harvard Medical School and completed a residency and fellowship in primary care and general internal medicine at Brigham and Women’s Hospital. Dr. Barnett’s research focuses on understanding and improving the health care delivery system with a specific interest in the opioid crisis, nursing homes and studying innovative models for health care payment and care delivery.  

Reference:

McGarry BE, SteelFisher GK, Grabowski DC, Barnett ML. COVID-19 Test Result Turnaround Time for Residents and Staff in US Nursing Homes [published online ahead of print, 2020 Oct 30]. JAMA Intern Med. 2020;e207330. doi:10.1001/jamainternmed.2020.7330