Constance Stager, MT(ASCP), ASCLS Region IX Director

The reliance on air travel for healthcare professionals in Southeast Alaska has added barriers to the already complex situation dealing with COVID-19.

Photo credit: Steve Halama, Unslpash

We have all been impacted by this global pandemic, and Southeast Alaska is no exception. I am the director of laboratory services for two high-complexity laboratories, five moderate-complexity laboratories, and about 30 point of care (POC) sites in Southeast Alaska. These labs are physically distant, on separate islands; travel between the sites is accomplished by small plane or ferry service. This makes commuting to work, in an area about the size of Florida, a unique experience. On good weather days there are fabulous views of beautiful scenery and ice blue glaciers. Often though, travel is fraught with numerous weather delays, and I have had more than a few white-knuckle experiences due to a rough and bumpy ride in a seven-seat Cessna plane.

Challenges of Distant Communication

Due to our unique geography, the labs that I oversee are used to dealing with the challenges of distant communication. Many of our POC sites are in remote Alaska villages with a small clinic as the only healthcare serving the several hundred residents of that village and the surrounding area. Specimens from the village sites are flown to one of the larger sites to be run or processed for send-out to a reference lab. When the weather is bad, there are times when there is no travel in or out of the village for over a week. In-person travel and training are often not an option.

Despite these challenges, it is our mission to provide high quality healthcare and lab services to all patients, and we take pride in our ability to accomplish this goal. My staff and I have worked to implement cutting edge tools that allow even our most remote POC labs to be interfaced with our robust and dynamic laboratory information system (LIS), which has QC and maintenance function built in. My lab staff can oversee POC testing and review quality control from anywhere in the system. Use of these technologies has been vital to our ability to maintain the highest quality standards despite turnover of lab staff, use of locums, and POC testing without onsite laboratory oversight.

“Frequent communication has allowed us to relay changes concerning the ability to obtain supplies, changes in shipping, and other challenges affecting our ability to provide services, and has allowed us to meet the needs of our patients.”

The pandemic, though, has just added another layer of complexity. In March we began to find that not only did we have difficulty obtaining collection supplies that would allow us to collect COVID-19 specimens for send-out to our reference laboratory, but disruptions to flights coming from the lower 48 meant that we had difficulty obtaining basic laboratory supplies and difficulty shipping our specimens out for testing. Many of these issues are not unique to Alaska, but our reliance on air travel was certainly an added barrier. Flights in and out of the Alaska were curtailed as routes were reduced and even the small carriers with flights between villages were dramatically cut back leaving limited options and opportunity to fly specimens out for testing or get supplies in.

Rapid and Frequent Change

Like everyone else, we have had to adapt to a rapidly changing environment. It has been my experience that those that choose to enter the lab field do not, as a rule, like rapid change. Generally, laboratorians prefer to be methodical and take the time to carefully implement new instruments, procedures, and workflows after careful consideration. Dealing with this pandemic has turned much of that on its head. Laboratories have had to deal with rapid and frequent change just to stay current, and I am proud to say that I have seen my staff adapt, doing whatever is necessary to serve our patients.

Despite the challenges, and personnel shortages, we have implemented rapid testing in our village locations and new analyzers in our labs. We have relied heavily on the use of telecommunications tools to stay in touch with each other despite the distance, and we even have the employee who oversees our LIS working from her home in North Carolina. With video we have provided remote sites training on new instrumentation and overseen their quality using our LIS tools. Frequent communication has allowed us to relay changes concerning the ability to obtain supplies, changes in shipping, and other challenges affecting our ability to provide services, and has allowed us to meet the needs of our patients.

What will be next in this global pandemic and how it will affect all of us in the laboratory has yet to be seen. We are all preparing for the fall and the coming flu season. As we all know, most of us in the lab cannot work remotely and must come to work and process the samples and perform the testing to give the doctors the tools they need to save lives. The tools available to me as a manager have allowed me to direct the efforts of the lab heroes who come to work each day despite the risk and provide this vital service to our patients, even those in the most remote places.

Constance Stager is Director of Laboratory Services at the SouthEast Alaska Regional Health Consortium (SEARHC).