Abstract
This study presents two simulation modelling tools to support the organisation of networks of dialysis services during the COVID-19 pandemic. These tools were developed to support renal services in the South of England (the Wessex region caring for 650 dialysis patients), but are applicable elsewhere. A discrete-event simulation was used to model a worst case spread of COVID-19, to stress-test plans for dialysis provision throughout the COVID-19 outbreak. We investigated the ability of the system to manage the mix of COVID-19 positive and negative patients, the likely effects on patients, outpatient workloads across all units, and inpatient workload at the centralised COVID-positive inpatient unit. A second Monte-Carlo vehicle routing model estimated the feasibility of patient transport plans. If current outpatient capacity is maintained there is sufficient capacity in the South of England to keep COVID-19 negative/recovered and positive patients in separate sessions, but rapid reallocation of patients may be needed. Outpatient COVID-19 cases will spillover to a secondary site while other sites will experience a reduction in workload. The primary site chosen to manage infected patients will experience a significant increase in outpatients and inpatients. At the peak of infection, it is predicted there will be up to 140 COVID-19 positive patients with 40 to 90 of these as inpatients, likely breaching current inpatient capacity. Patient transport services will also come under considerable pressure. If patient transport operates on a policy of one positive patient at a time, and two-way transport is needed, a likely scenario estimates 80 ambulance drive time hours per day (not including fixed drop-off and ambulance cleaning times). Relaxing policies on individual patient transport to 2-4 patients per trip can save 40-60% of drive time. In mixed urban/rural geographies steps may need to be taken to temporarily accommodate renal COVID-19 positive patients closer to treatment facilities.
Highlights
Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2) and the disease it causes COVID-19 is causing widespread disruption to normal healthcare services, as the number COVID-positive cases increases
Rapid guidelines for dialysis service delivery have been published [2,3,4]. These include separation of COVID-positive and COVID-negative patients; dialysis units working with transport providers to minimise the risk of cross-infection; and continuing to treat patients as close to home as possible. [2]
If COVID progresses through 80% of the population in three months at the peak, there are up to about 125 COVID-positive patients (115-140 across the 30 model runs)
Summary
Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS-CoV-2) and the disease it causes COVID-19 ( known as COVID) is causing widespread disruption to normal healthcare services, as the number COVID-positive cases increases. In the UK a worst case scenario is that 80% of the population are infected over a three month period, if controls are not put in place [1]. Social distancing measures are in place both in the UK and internationally, patients with Chronic Kidney Disease who must visit dialysis units are limited in their ability to be fully isolated. Rapid guidelines for dialysis service delivery have been published [2,3,4]. These include separation of COVID-positive and COVID-negative patients; dialysis units working with transport providers to minimise the risk of cross-infection; and continuing to treat patients as close to home as possible. These include separation of COVID-positive and COVID-negative patients; dialysis units working with transport providers to minimise the risk of cross-infection; and continuing to treat patients as close to home as possible. [2]
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