Resource utilization and provision of in-hospital dialysis in an academic hospital in New Orleans During the COVID-19 pandemic

ABSTRACT

Background: COVID-19 has caused an ominous healthcare toll in the United States. New Orleans rated among the top affected cities. Acute kidney injury (AKI) requiring renal replacement therapy (RRT) affected 16% of COVID-19-related hospitalizations, resulting in an exponential upsurge in resource utilization related to RRT. We report our single center experience providing metrics of overall utilization and workforce expansion. Methods: We conducted a prospective collection of data of daily census of hospitalized patients with COVID-19 and AKI or ESKD for 7 weeks (3/8-4/30, 2020) quantifying usage of RRT equipment and allocation of personnel. Two independent electronic health record databases were simultaneously used to track the data. Results: Within 1 month, in-hospital COVID-19 census peaked at 377 patients, with 97 (26%) of them receiving RRT at peak day. Starting from a mean of 65 patients on RRT per day in pre-COVID-19 era, the estimated RRT growth peaked at 49%. Four out of 10 newly purchased Fresenius K2 SLED machines (FKs) were utilized by week 5 (after delivery, assembly and negative culture). Starting from an average 80% usage of baseline capacity (31 of 38 FKs), usage of 42 K2s at peak revealed 35% growth. Four new reverse osmosis devices were obtained (growth 25 to 29, 16%) by week 5. For CVVHDF, 4 PrismaFlex machines (PFs) were rented and 10 new PrisMax were bought. Starting from an average 33% usage of baseline capacity (2 of 6 FKs), use of 6 PFs at peak meant 400% growth. Up to 30 nurses were trained virtually on RRT. Eight agency nurses and 6 perfusionists were recruited, to increase the operator number from 21 to 35 (67% growth). Five of 21 (24%) RRT nurses were out of work at peak due to COVID19+ status. One attending physician, 1 nurse practitioner and 2 subspecialty residents were added to the inpatient service, increasing the number of providers from 9 to 13 (44% growth). Conclusions: The pandemic of COVID-19 resulted in substantial increase in inhospital RRT demand and resource utilization. Our experience may provide other centers a guide to optimize preparedness in the event of facing a 'second wave' of COVID-19 in the near future. Delay in implementation has to be accounted for during strategic planning.