Authors (including presenting author) :
Yuen SK (1), Cheong HY (1), Yuen Higgins (2), Lee Larry (2)
Affiliation :
(1) Department of Medicine & Geriatrics, Caritas Medical Centre (2) Cluster Service, Hospital Authority
Introduction :
The 5th wave attack of COVID-19 epidemic brought with a surge in the number of infected hemodialysis (HD) patients, far exceeding the capacity of all Hong Kong public HD centres. Against a background of ward congestion and access block, functional ineffectiveness to dialyze HD patients was apparent due to limited isolation facilities, machine quarantine and staff deployment. Staff absenteeism, evolving quarantine and discharge criteria were additional challenges.
Objectives :
A decision was endorsed on 24 February 2022 to convert Caritas Medical Centre (CMC) renal unit into a Hospital Authority (HA) designated HD centre to support ambulatory patients across the territory. The aim was to relieve pressure of all renal centres by improving efficiency.
Methodology :
Hospital facility managers confirmed feasibility and scheduled hardware adjustment and testing (especially ventilation) to ensure compliance with the infection control standards. New staff and patient movement paths were drafted; gown-up and gown-off areas relocated. Frontline staff volunteered cancelation of annual leave and actively participated in special honorarium scheme (SHS). Infection control refresher course was arranged. Supervisors provided regular briefing, on-site clinical consultations, uphold team spirit and facilitated trans-disciplinary psychological support. HA-chat was utilized for clinical and operational communications.
HD patients infected by COVID-19 of various hospitals were recruited via close communication between the parent hospitals, HA head office and CMC renal unit. Designated transportation (by coach or taxi) was arranged for patients to travel between Penny Bay Community Isolation Facility or home and CMC. A local patient movement workflow was implemented to ensure isolated movement paths for patients between their arrival spot and the HD suite. The point-to-point transport minimized possible contact of COVID positive patients with the community while ensuring their regular, scheduled attendances to life-sustaining HD sessions. A nephrologist provided individualized clinical evaluation and management, ensured clearance of the virus before discharging the patient back to the original HD centre.
Result & Outcome :
From 1 March 2022 till 21 April 2022, nine hundred sessions of HD were performed on 129 COVID positive patients at the designated HD centre. Clinical admissions post-HD were arranged for 5 and 6 patients for COVID-related and unrelated medical conditions, respectively. Two patients died of COVID-unrelated causes after hospitalization. A satisfaction survey on 38 frontline ward staff showed high median scores in all domains, including overall assessment, operation, staff training and support, resources, and ward environment.
