Winning Solution: Dashboards to Facilitate COVID-19 Disaster Response

The unprecedented surge of hospitalized patients with acute kidney injury during the COVID-19 pandemic in New York City created logistical challenges to ensure patients continued to receive appropriate renal replacement therapy (RRT). The unprecedented demand, coupled with resource supply limitations, created an urgent need for novel data-management resource-tracking tools that also support the efficient sharing of RRT equipment. These tools provide operational awareness of resource supply levels and supply chain capacity, which were essential prerequisites to maximize RRT capacity at the appropriate dose of dialysis. Dialysis machine sharing protocols necessitated by the surge were facilitated by rapid identification of patient pairs that could share a machine despite the rapid patient turnover that resulted from high patient mortality. These tools allowed logistics optimization, which in turn decreased the number of nurses exposed to COVID-19. These tools facilitated an organized, data-driven response and rapid reorganization of kidney services — resulting in requests for the tools from other organizations.

Our dashboards relied on manually entered patient census and clinical information to guide decisions on shared protocols. While our dashboards were designed to support the challenges of a large program like ours, they are also adaptable to smaller programs and outpatient dialysis units. Our dashboard tools have been described extensively in peer-reviewed literature and referenced in the ASN COVID-19 toolkit. They are available for download, given the potential value for other institutions facing a similar surge of patients with kidney injury requiring RRT. Potential future enhancements include improving the dashboard functionality with automated data retrieval using bioinformatics standards, facilitating customization for varying needs and organizations, and enhancing the intuitive user interface and reporting functionality.

Having recognized the value of our tools in support of our disaster response, we are determined to make them widely and easily accessible to support other programs. To this end, the tools in their “out of the box” form are available for use by any program. These tools can also be modified to meet the specific needs of an institution, but would require, at minimum, an intermediate ability to understand how to leverage some of the more advanced features in Excel spreadsheets. We recognize that this skill does not exist within each nephrology program that wishes to adapt our tools. The next steps are to work with someone with programming knowledge and a bioinformatics background in order to convert the tools into more user-friendly versions.

Finally, while these tools were designed for patients with kidney disease with a focus on dialysis as a shared resource, they could easily be adapted for any group wishing to track COVID-19 patients. Specifically, hospital systems could use them to facilitate reorganization to COVID-19 wings or units based on the proportion of COVID-19 positive patients on the inpatient census. Other consultative services such as cardiology, gastroenterology, or pulmonary/critical care could also use the patient tracking tool without modification to help reorganize their consult services. And while we initially designed the continuous renal replacement therapy (CRRT) sharing protocol for patients requiring continuous dialysis, it could easily be leveraged by a hospital’s admitting office or bed management to pair COVID-19 positive patients with other COVID-19 positive patients and COVID-19 negative patients with other COVID-19 negative patients to reduce nosocomial transmission of COVID-19.

Dr. Stevens is an Assistant Professor of Medicine in the Division of Nephrology at Columbia University Medical Center. He majored in Neuroscience at Bowdoin College before attending Dartmouth College School of Medicine. He completed his internal medicine residency training at Massachusetts General Hospital where he served as Chief Resident during his senior year. He then completed his nephrology fellowship at Columbia University Medical Center where he was also Chief Fellow during his senior year. His clinical and research interests include critical care nephrology and improving the care provided to patients with acute kidney injury and he is the Medical Director of Acute Care Nephrology at Columbia University Irving Medical Center.