Table 3.
Major challenges and responses to the severe acute respiratory syndrome coronavirus 2 pandemic
| Challenge | Response | Comments |
|---|---|---|
| Organization | Development of a multidisciplinary crisis team with broad representation of physician, nursing, and administrative staff | At peak, ICU beds increased from 139 to 312. OR and cardiac catheterization suites were converted to ICUs. CRRT performed in OR (perfusionists) and regular ICUs (nursing staff) |
| Reorganization of attending and fellow inpatient rotations | ||
| Flexible clinical service structure based on volume data | ||
| Communication | Daily crisis team video call | Supplemental Figure 1 |
| Liaison with institutional workgroups and leadership. Daily intercampus conference call | ||
| Communication with industry | ||
| Communication with regulatory agencies | ||
| Advice from medical centers with special expertise | ||
| Tracking information | Tracking daily census on inpatient services | Supplemental Figures 2–5 |
| New tools for tracking inpatient volume, dialysis machines, and supplies | ||
| Predictive models for patient volume and resources | ||
| Inpatient services | Transition to weekly schedule and adjustment of clinical service based on patient volume | Inpatient services increased from six (hemodialysis, transplant, consults, CRRT, nephro-cardiac, and Allen [Community Hospital]) to nine geolocalized services and one virtual consult service. Number of CRRT patients increased from an average of 20 presurge to a peak of 65. A pediatric renal fellow redeployed to the adult inpatient service |
| Rapid redeployment of attendings, fellows, and research staff | ||
| Geolocalization of services | ||
| Inpatient telemedicine service | ||
| Inpatient RRT | Multi-institutional workgroup to track dialysis resources | 40 new and five rental CRRT machines acquired for six hospitals |
| Interhospital sharing of RRT resources | Ten nurses and four technicians were provided by a CRRT vendor | |
| Daily CRRT huddle to prioritize RRT needs | Identification of “hot spots” based on daily crosscampus teleconference and immediate redeployment of CRRT machines or personnel | |
| New protocols for in-house dialysate production | ||
| Redeployment of research coordinators to assist in the dialysis unit, tracking CRRT machines, and preparation of CRRT dialysate | ||
| Outpatient CKD and ESKD care | Complete conversion to telemedicine | |
| Maintain essential infusions and kidney biopsies | ||
| Dedicated COVID-19+ outpatient dialysis unit | ||
| Redeployment of research coordinator as telemedicine navigators | ||
| Transplantation | Suspension of transplantation program | |
| COVID-19–free and COVID-19–positive designated wards and separate outpatient facilities | ||
| Redeployment of nurses and coordinators to telemedicine calls for outpatients | ||
| Establishment of a registry of patients with COVID-19 and PUI | ||
| Daily calls to all outpatients with COVID-19 and PUI for monitoring/management | ||
| Academic mission | Maintain academic conferences | |
| Convert research efforts to remote activities | ||
| Outreach to participants in observational studies | ||
| Covid-19 IRB protocol for observational studies | ||
| Coordinated COVID-19 research plans | ||
| Share early experience with COVID-19 with community | ||
| Morale and safety | Assignment of at-risk staff to telemedicine activities | |
| Participation of all members of the division in clinical or research activities | ||
| Frequent communication with division members with communication of good news | ||
| Maintenance of administrative activities, promotions, and hiring | ||
| Planning for post-COVID-19 ramp-up |
OR, operating room; PUI, persons under investigation; IRB, institutional review board.