WinnerPatient-centered Monitoring and Intervention During the COVID-19 Pandemic
Implementation of a structured workflow to aggregate COVID-19 data, provide a proactive assessment of kidney transplant patients for COVID-19 and manage kidney transplant recipients with suspected or confirmed COVID-19. Standardized documentation and data visualization tools allow for comprehensive patient monitoring and rapid, iterative improvements in patient care strategies.
To mitigate the risk posed by the COVID-19 pandemic on solid organ transplant patients, it was critical to develop a practical, scalable, and sustainable process to identify and track kidney transplant patients with COVID-19. Given the rapid increase in the number of affected individuals, limitations in terms of resources, and limited understanding of the optimal treatment strategies at the outset, it was imperative to establish a clear, systematic, and protocolized method for care. We developed a comprehensive data-driven approach that facilitates data collection as an integral part of our workflows. This allowed us to evaluate our processes of care and refine our approach to care for COVID-19-affected patients in an iterative manner.
Aggregating COVID-19 tests and proactive patient assessment Results from tests performed within the organization were available in the medical record, while external tests were initially captured through an electronic HIPAA-compliant questionnaire software tool and transcribed into discrete fields within the medical record. The questionnaire was posted on the transplant intranet site and sent via email on a daily basis for team members to enter information. Fields captured patient demographics including name, date of birth, transplant date, as well as the date and result of SARS-CoV-2 PCR test and test location.
Data summarization and outcomes sharing Internal and external SARS-CoV-2 PCR test results were abstracted and linked with other clinical information about the patients from their medical records, including age, race, ethnicity, blood type, comorbidities, hospitalization details (if applicable), and treatments received. Analyses included a calculation of test positivity rate, hospitalizations, need for intensive care unit (ICU) admission, hospital length of stay, time to COVID-19 after transplant, and outcomes including disease resolution or mortality. These metrics were displayed on a data visualization dashboard on the secure intranet site and could only be accessed by the transplant team.
Implementation and adaptability
Our multidisciplinary team was comprised of clinicians, administrative staff, individuals from information technology, and transplant analytics — all of whom collaborated to develop a workflow; create tools to capture, display and disseminate information; and report on outcomes for continuous improvements. Staffing to facilitate the patient-facing interactions in the workflow was accomplished through an internal redeployment of transplant program team members. For example, our pre-transplant staff was responsible for triaging more than 100 phone calls per day from patients who were experiencing COVID-19 symptoms or were known to have tested positive and who were being managed at home.
Tools such as the survey were created by leveraging existing software at the organization or available via open sources and an existing transplant service secure intranet site, called the "Transplant Community Toolbox," was used to store all documents, resources, plans, and the data visualizations.
The work that we conducted to implement structured workflows to aggregate COVID-19 data, proactively assess kidney transplant patients for COVID-19, and manage kidney transplant recipients with suspected or confirmed COVID-19 was nimble. It would be possible to expand and translate this model to different settings. Creating standardized workflows allowed for streamlined documentation and the creation of data visualization tools. In our process, this allowed for comprehensive patient monitoring and rapid iterative improvements in patient care strategies. The program that we implemented is generalizable and can be replicated at any institution caring for transplant recipients or other specialized patient cohorts. The tools developed in our phased approach are available either through organizational licenses or open sources. In addition, the exact software that we utilized is not required, as the process can be implemented with resources likely available at most health systems, including for example, questionnaire software, medical record system, and statistical analytic tools.
The impact of the COVID-19 pandemic on patient outcomes has varied from one transplant center to another. It is important for each center to understand the prevalence, clinical outcomes, and medical resources needed to keep their patient population safe, assure the best outcomes, and contribute knowledge to the scientific community. Overall, the blueprints of this workflow and process implementation could be replicated at any facility and even for the care of other specialized patient populations.