Abstract: PO0868
Renal Critical Care Project Management of COVID-19 Pandemic Surge
Session Information
- COVID-19: Clinical and Basic Science Characteristics
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Barnett, Richard L., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
- Fishbane, Steven, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
- Finger, Mark A., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Background
The COVID-19 surge for the NY area severely stretched hospitall resources as critical care areas expanded 2-3 fold. In addition to well chronicled ventilator management of respiratory failure, 37% sustained some degree of AKI with many requiring continuous renal replacement therapy (CRRT). The challenge of providing optimal renal critical care given unprecedented demand was met with a defined project plan which required close integration of physician, nursing, pharmacy and materials management resources over multiple hospital sites
Methods
The Renal Critical Care Project Management Team (T) initially met on 3/11 and identified likely shortfalls in the quantity of Baxter Prisma machines for Long Island Jewish and contiguous Cohen Children's Hospital (LIJ 7), Southside Hospital(SSH 3) and NorthShore University Hospital (NSUH 18). 10 PrisMax and an additional 5 Prismaflex were delivered to NSUH and redeployed as required. Alternative CRRT fluid supplies were defined as T precluded acute PD. Spot shortages of machines, fluids and filter sets by 3/26 finalized the creation of multisite T with project manager selected from Central Procurement. Detailed communication plan kept all components and sites informed of daily changes.
Results
During the Pandemic Peak 4/3-5/1 T met daily. From 445-845 am Director of Renal Critical Care examined the electronic records from 74-92 COVID+ patients receiving CRRT, HD OR deemed likely to require RRT in the near future, and reviewed with each renal provider. At 9am T examined supplies of machines, fluids and filter sets, requiring daily shift of resources among each site 4/3-4/24. Machines were redeployed SSH(6), LIJ(13) and NSUH(24) with 36 peak total daily usage. Each patient averaged 13 five L/bags fluid daily which could be reduced by SCUF or other methods. Pre COVID filter life of 22 hours declined by half in these hypercoagulable patients only partially offset by step wise anticoagulation strategy. Fluid supplies during these 3 weeks averaged 1-2 days with low 0.25 on 4/22. A SLED program was initiated 4/21. FIVE day fluid and filter supplies were delivered 4/24.
Conclusion
The magnitude of the COVID-19 surge required tight project management to ensure adequate renal critical care. The ability to shift resources among multiple sites using CRRT was a major key to success. This integrated approach may have application for future pandemic surges.