Dialysis Service Modelling in Portsmouth

Project Summary

The Wessex Kidney Centre cares for 650 dialysis patients through a network of nine units in the South of England. People requiring renal replacement therapy are particularly vulnerable to COVID19 and, due to the requirement to travel for treatment, are unable to social distance to the same extent as the rest of the population. At the early stage of the epidemic in the UK, NIHR PenARC and IDSAI researchers collaborated with NHS professionals at the Wessex Kidney Centre to produce rapid evidence to support the redesign of the dialysis service.

PenARC’s experience in NHS operational research allowed them to mobilise rapidly, delivering the evidence within two weeks. Due to the nature of the epidemic, the project was highly dynamic and the team extended the scope of the study during the second week to support an emerging urgent problem with patient transport.

Project Activity

The team used advanced computer simulation methods to model the dialysis network and transport of patients to units. By modelling a range of infection scenarios, the team investigated the impact of COVID19 on outpatient, inpatient and patient transport services.

Project Outputs

The study found that the most resilient approach was to centralise care of infected outpatients at the Queen Alexandra Hospital Portsmouth with surge capacity at Basingstoke Hospital. Regional capacity plans for patient transport to dialysis were found to be insufficient. The study recommended that existing services could be reconfigured to reduce transport time by 50-60% and that this would need to be supported by a temporary accommodation for infected patients located closer to the centralised unit.

• A preprint of the study is available on medRvix
• The research followed an open research approach and study data and models are available (with an MIT license) to be used/reviewed by others via the University GitLab: https://git.exeter.ac.uk/tmwm201/dialysis-service-delivery-covid19
• The study is under review at PLOS1
• Paper: Organising outpatient dialysis services during the COVID-19pandemic. A simulation and mathematical modelling study. (corresponding author: Mike Allen), published 27/04/2020.
• News story: https://www.arc-swp.nihr.ac.uk/news/2020/06/30/reorganising-dialysis-services-during-the-covid-19-outbreak

NHS Impact

Feedback received:

Steve Dudfield, General Renal Manager, Wessex Kidney Centre

“This is brilliant… it has been extremely helpful enabling us to plan for the demand implications of COVID-19 with a high degree of confidence.”

Jonas Willemsen, Renal Information and Systems Manager, Wessex Kidney Centre

“We’re bowled over by how quickly [the team] turned this around… I think this is going to be (and indeed already is) transformative to our handling of the outbreak.”

Amir Bhanji, Consultant Nephrologist, Portsmouth Hopsitals NHS Trust

“The modelling was very helpful in providing a basis on which we could change the way we work in preparedness the number of COVID cases. We relocated patients to more appropriate satellite dialysis units to free up space in our main unit to manage the number of patients. We negotiated the use of an extra inpatient ward with the trust in case we saw a large increase in the number of dialysis inpatients. We also paid patients who were able to make their own way into the units to free up the patient transport service. As a unit we felt we were well prepared for the worst case scenario thanks to the model.”