Key challenges

• A variety of approaches to segregation and isolation were implemented across London; there was no clear signal that one isolation strategy was more effective than others
• Clinical leadership and collaboration across the whole of London with mutual support
• Collaboration and sharing of workforce within services and across services with rapid onsite training and refresher courses—medical students, dentists, surgeons, dieticians, pharmacists provided full support to dialysis patients
• Meet and Greet triage of all patients provided a welcome and reassurance from staff
• Patient HELPLINE provided in various forms by telephone or email provided access to information regarding treatment options during COVID-19 allowing signposting and triage of a spectrum of patient issues raised during COVID-19 as a result of changes in ordinary processes
• Kidney Care UK website provided timely high quality accessible patient information
• Transport Hub—to share regular capacity information and create pan-London guidance
• Active engagement and support of all staff, either sick or shielding, by senior leadership teams either by face-to-face visits or regular phone calls
• Promotion or expansion of home therapies programmes as a treatment option to minimise risk
• Written communication to all patients to maintain updates on the latest guidance.
• Trust websites hosting key information with useful links for patients
• Scripted information for teams to communicate to patients for consistency and clarity
• Renal dietitians were placed in some satellite units to support with diet/fluid management for patients on reduced hours/twice weekly dialysis

What could we do better?

• Maintain renal nursing expertise in HD and PD
• Maintain and assure equity of access to other services such as low clearance, supportive care, transplant and vascular access
• Communication with patients and carers, especially if an inpatient; consider examples of good practice like a daily telephone update
• Provide more comprehensive wellbeing support for patients and staff
• Providing better peer support – access to other patients’ experiences and sharing of information - active peer supporting in the young adult patient community throughout this time has helped both with practical but also psychological challenges that people have faced
• Easily accessible information using technology to enable equity of access for the hard of hearing, partially sighted, other disabilities and for those who are hard to reach.
• Escalation plans on, or prior to, admission— using validated frailty tools and Advanced Care Planning to facilitate conversations and prepare patients and families for these decisions
• Improve patient information: Keep It Short and Simple (KISS). Explain all technical language and make sure it's read and sense checked by a wide range of patients