Policy and Pandemic: The Changing Practice of Nephrology During the Coronavirus Disease-2019 Outbreak

Truong, Tiffany; Dittmar, M.; Ghaffari, Arshia; Lin, Eugene

doi:10.1053/j.ackd.2020.06.003

Cited by 20 publications

(32 citation statements)

References 35 publications

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“…As a consequence of the unprecedented stalling of health care services, telemedicine use rose. 31,32,33 Telemedicine is beneficial beyond maintenance of social distancing and a way to get medical advice but also cuts down travel expenses, reduces the time spent in travelling and waiting for consultations and the loss of workdays. In resource-limited countries with significant rural populations, the impact of telemedicine in improving the access and quality of delivered health care to people with chronic conditions, such as CKD, can be particularly significant.…”

Section: Delivery Of In-person and Remote Care During Covid-19mentioning

confidence: 99%

“…These therapies also keep the patients safe from infection, limit the stress on facilities and protect healthcare workers. As a consequence of the unprecedented stalling of health care services, telemedicine use rose 29‐31 . Telemedicine is beneficial beyond maintenance of social distancing and a way to get medical advice but also cuts down travel expenses, reduces the time spent in travelling and waiting for consultations and the loss of workdays.…”

Section: Challengesmentioning

confidence: 99%

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COVID‐19 and care for patients with chronic kidney disease: Challenges and lessons

Divyaveer

Jha

2021

FASEB BioAdvances

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The COVID-19 pandemic has blurred the traditional distinction between communicable diseases (CD) and noncommunicable diseases (NCDs). The manifestations of COVID-19 range from an asymptomatic carrier state to fatal multiorgan failure. While initial reports did not report significant effects on the kidneys, it is now well established that kidney involvement (acute kidney injury, urinary abnormalities, tubular function defects) in COVID-19 is common and also associated with poorer outcomes. At the same time, care for patients with existing chronic kidney disease (CKD) has suffered during this pandemic and those with CKD are considered higher risk for severity of COVID-19 symptoms. Widespread lockdowns have affected the delivery of health care to patients with CKD, including those on dialysis or on transplant wait-lists. The pandemic has reinforced the need for accessible home-based therapies and highlighted the value of teleconsultation and remote monitoring technologies. COVID-19 has revealed the poor emergency preparedness by health systems around the world. It has underscored glaring inequities in availability of diagnostic tests and essential medications in different countries, including for dialysis. In response, there has been increasing recognition of the necessity of universal health coverage and in prioritizing vaccine distribution to serve the most vulnerable, including those with renal failure. The COVID-19 pandemic has also reaffirmed the role of the environment and ecosystems contributing to both CDs and NCDs. Attention to universal health coverage through a One Health approach is needed to prevent global health crises and prevent furtherkidney dysfunction and failure.

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Section: Delivery Of In-person and Remote Care During Covid-19mentioning

confidence: 99%

Section: Challengesmentioning

confidence: 99%

COVID‐19 and care for patients with chronic kidney disease: Challenges and lessons

Divyaveer

Jha

2021

FASEB BioAdvances

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“…Improving working conditions is necessary for minimising stress and burnout in clinical staff [ 42 ]. COVID-19 has transformed healthcare infrastructure such as the expansion of telehealth and virtual clinics [ 43 ]. Renal HCPs described successful collaborations between primary and secondary care however changes to traditional working practices that included non-face-to-face interactions tended to be less appealing to staff.…”

Section: Discussionmentioning

confidence: 99%

Experiences of renal healthcare practitioners during the COVID-19 pandemic: a multi-methods approach

et al. 2021

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Background Globally, renal healthcare practitioners provide intensive and protracted support to a highly complex multi-morbid patient population however knowledge about the impact of COVID-19 on these practitioners is extremely limited. Objective This study aimed to explore the experiences of COVID-19 with renal healthcare practitioners during the first global lockdown between June 2020 and September 2020. Methods A multi-methods approach was carried out including a quantitative survey and qualitative interviews. This was a multinational study of renal healthcare practitioners from 29 countries. Quantitative: A self-designed survey on COVID-19 experiences and standardised questionnaires (General Health Questionnaire-12; Maslach Burnout Inventory). Descriptive statistics were generated for numerical data. Qualitative: Online semi-structured interviews were conducted. Data was subjected to thematic analysis. Renal healthcare practitioners (n = 251) completed an online survey. Thirteen renal healthcare practitioners took part in semi-structured interviews (12 nurses and 1 dietician). Results The majority of participants surveyed were female (86.9 %; n = 218), nurses (86.9 %; n = 218) with an average 21.5 (SD = 11.1) years’ experience since professional qualification, and 16.3 years (SD = 9.3) working in renal healthcare. Survey responses indicated a level of preparedness, training and satisfactory personal protective equipment during the pandemic however approximately 40.3 % experienced fear about attending work, and 49.8 % experienced mental health distress. The highest prevalence of burnout was emotional exhaustion (35.9 %). Three themes emerged from the qualitative analysis highlighting the holistic complexities in managing renal healthcare, a neglected specialist workforce, and the need for appropriate support at work during a pandemic. Conclusions Results have highlighted the psychological impact, in terms of emotional exhaustion and mental health distress in our sample of renal healthcare practitioners. As the pandemic has continued, it is important to consider the long-term impact on an already stretched workforce including the risk of developing mental health disorders. Future research and interventions are required to understand and improve the provision of psychological support for specialist medical and nursing personnel.

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“…We were able to identify a study [ 8 ], from the USA in the literature, which described the changing practice of nephrology during the COVID-19 pandemic. Policy and healthcare infrastructure transformed in response to the challenges of the COVID-19 pandemic, included strategies for resource management, an expansion of tele-medicine and home dialysis modalities, refined guidance on dialysis access procedures, extra measures to relieve administrative burden, and a re-evaluation of quality metrics.…”

Section: Discussionmentioning

confidence: 99%

“…This is also reflected in the fact that the proportion of incidents reported did not decrease. The fact that the proportion of incidents reported did not decrease with the additional demands imposed by the pandemic, such that the Parliamentary and Health Service Ombudsman paused their work on existing NHS complaints and acceptance of new health complaints from 26 March 2020 to 30 June 2020, [ 8 ] was also reassuring as it suggested possible continued vigilance for patient safety in the NUH FH division.…”

Section: Discussionmentioning

confidence: 99%

Impact of New Clinical Policies during the COVID-19 Pandemic on Clinical Incidents and Complaints at a UK Teaching Hospital

Atiomo

Weir

Kean

2021

IJERPH

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Background: To investigate any associations between new clinical policies implemented because of the COVID-19 pandemic and harm to patients. Methods: Retrospective data collection of incidents and complaints reported through Datix®, and the Patient Advice and Liaison Service (PALS), respectively. The setting was the Family Health division in a University teaching hospital in the UK. Primary and secondary outcome measures included: the proportion of incidents reported on Datix® from 23 March 2020 to 29 May 2020, compared to the period from 23 March 2019 to 29 May 2019. COVID-19 related incidents and complaints and association with newly published guidelines or pathways from 23 March 2020 to 29 May 2020 were investigated. Results: There was no significant difference in the proportion of overall patient activity resulting in incidents reported on Datix in 2020 (2.08%) compared to 2019 (2.09%), with 98% resulting in no/low harm in 2020. Three incident categories had increases in relative proportions of incidents including the terms “COVID” or “Corona” compared to incidents that did not: “Child death”, “delay/failure to treatment and procedure” and “information governance”. One of the child deaths was a miscarriage and we were unable to link the second child death to a change in clinical policy at this stage. We were only able to link two COVID-19 associated incidents with a pathway or procedural change (one to the Children’s Emergency Department admission pathway and the second to the introduction of virtual antenatal clinics). Eighteen complaints related to COVID-19 were logged. However, at this stage, we are unable to link any of these to a published change in clinical policy. Conclusions: New policies introduced in the division, during the COVID-19 pandemic were associated with similar rates of clinical incidents, when compared with the previous year. There were only two COVID-19-related incidents clearly related to a change in pathways and procedures. Continued surveillance and improved metrics for monitoring the impact of changes to pathways and procedures should be sought with the sustained presence of COVID-19 in clinical areas.

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Policy and Pandemic: The Changing Practice of Nephrology During the Coronavirus Disease-2019 Outbreak

Cited by 20 publications

References 35 publications

COVID‐19 and care for patients with chronic kidney disease: Challenges and lessons

COVID‐19 and care for patients with chronic kidney disease: Challenges and lessons

Experiences of renal healthcare practitioners during the COVID-19 pandemic: a multi-methods approach

Impact of New Clinical Policies during the COVID-19 Pandemic on Clinical Incidents and Complaints at a UK Teaching Hospital

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