International Journal of Nephrology and Renovascular Disease (Oct 2020)
Inpatient Dialysis Planning During the COVID-19 Pandemic: A Single-Center Experience and Review of the Literature
Abstract
Kevin R Mitchell,1– 3 Alison Bomm,3,4 Barry S Shea,2,3,5 Douglas Shemin,1– 3 George Bayliss1– 3 1Division of Kidney Diseases and Hypertension, Brown Medicine, Providence, RI, USA; 2Alpert Medical School, Brown University, Providence, RI, USA; 3Department of Medicine, Rhode Island Hospital, Providence, RI, USA; 4Department of Nursing, Rhode Island Hospital, Providence, RI, USA; 5Division of Pulmonary and Critical Care Medicine, Brown Medicine, Providence, RI, USACorrespondence: George Bayliss APC 9, Rhode Island Hospital, 593 Eddy St, Providence, RI RI 02903, USATel +1-401-444-3284Fax +1-401-444-3283Email [email protected]: COVID-19 has created havoc in healthcare systems worldwide, including shortages in equipment and supplies for dialysis in the acute setting.Methods: We compared our planning and experience at a tertiary care academic medical center to recommendations in the literature.Results: Published literature and our experience underscored the need to plan for adequate dialysis equipment, particularly for continuous renal replacement therapy in the ICU setting, adequate nursing, and flexible scheduling of chronic patients to accommodate the surge in acute patients. We discovered other “shortages” not mentioned in the literature: shortages in the number of portable reverse osmosis (RO) machines needed to prepare dialysis water, inadequate number of rooms in units designated for COVID-19 patients with plumbing for dialysis, and lack of temperature blending valves on sinks that necessitated using cold water only, and damaging the RO membranes. We identified the need for cooperation between nephrology and critical care medicine, hospital-based and community nephrologists and community dialysis units as well as nephrologists at other hospitals in the region. We turned to guidance from the hospital ethics committee.Conclusion: Planning for an expected surge in hospitalized patients requiring RRT demands coordination between critical care, dialysis and nursing services as well as community and hospital providers to make certain there are adequate dialysis resources. Our experience suggests that continuous dialysis is in greatest demand early in the illness, and that plans to increase supplies should be put in place. But, planning should also focus on unforeseen hospital-specific infrastructure shortages that can develop over time and hamper intermittent dialysis delivery to all patients who require treatment.Keywords: dialysis, disaster, planning, coordination
