Review of London kidney teams’ response to COVID-19
March-June 2020

Patient support, advice and information - 'let’s turn our faces to the front door'

1. Meeting and greeting patients is simple but effective
2. How can we ‘walk with’ patients better through their journey: explore options for named nurses or case managers
3. Choice (and information to support it) is ever more important - for example, the communication of risk associated with in-centre haemodialysis, and provision of pathways to facilitate home therapies or supportive care where chosen.
4. Advanced care planning and frailty assessments are essential and should be part of routine care and conversations with patients
5. There is an opportunity to improve patient information across London so that it is consistent, accessible and embraces technology, ideally through one repository
6. Wellbeing support for both patients and staff is vital

Infection control

1. A variety of approaches to segregation and isolation were implemented across London but there was no clear signal that one isolation strategy was more effective
2. Expansion and availability of home therapies as a treatment option can help to minimise risk
3. Provision of a transport hub with regular sharing of information about capacity, dynamic learning, and guidance reduced enabled units to balance the risk of missed dialysis sessions against the need to optimise infection control

Workforce

1. Collaboration and sharing of workforce within services and across services with rapid onsite training and refresher courses was vital

Next steps

• Use the London Networks to review workforce and consider a contingency approach to maintain renal services during a second surge
• Use the London Networks to convene a London patient information group with appropriate stakeholders
• Explore the meet and greet concept used during COVID-19, considering named clinicians, care navigators or case managers

Summary of discussions

What worked well?

• A variety of approaches to segregation and isolation were implemented across London; there was no clear signal that one isolation strategy was more effective than others
• Clinical leadership and collaboration across the whole of London with mutual support
• Collaboration and sharing of workforce within services and across services with rapid onsite training and refresher courses—medical students, dentists, surgeons, dieticians, pharmacists provided full support to dialysis patients
• Meet and Greet triage of all patients provided a welcome and reassurance from staff
• Patient HELPLINE provided in various forms by telephone or email provided access to information regarding treatment options during COVID-19 allowing signposting and triage of a spectrum of patient issues raised during COVID-19 as a result of changes in ordinary processes
• Kidney Care UK website provided timely high quality accessible patient information
• Transport Hub—to share regular capacity information and create pan-London guidance
• Active engagement and support of all staff, either sick or shielding, by senior leadership teams either by face-to-face visits or regular phone calls
• Promotion or expansion of home therapies programmes as a treatment option to minimise risk
• Written communication to all patients to maintain updates on the latest guidance.
• Trust websites hosting key information with useful links for patients
• Scripted information for teams to communicate to patients for consistency and clarity
• Renal dietitians were placed in some satellite units to support with diet/fluid management for patients on reduced hours/twice weekly dialy