A simulation modelling toolkit for organising outpatient dialysis services during the COVID-19 pandemic

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