key: cord-0702497-7deysugd
authors: Khan, Sobia; Mallipattu, Sandeep K.
title: Monitoring Hospitalized Dialysis Patients With COVID-19: Repurposing Baby Monitors for Patient and Staff Safety
date: 2020-12-10
journal: Kidney Med
DOI: 10.1016/j.xkme.2020.10.004
sha: d7ff12e472aaa4cad3535525864dc8b1a8e0f603
doc_id: 702497
cord_uid: 7deysugd

nan

To the Editor:

The appropriate and safe utilization of hospital resources has been at the forefront in the past few months during this initial wave of Coronavirus Disease 2019 pandemic. New York has been the epicenter of the COVID-19 pandemic in the United States and recent studies report that over 20% of patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) develop acute kidney injury (AKI), with nearly 15% of individuals requiring kidney replacement therapy (KRT) 1 . While the initial reports from Wuhan, China demonstrated a lower incidence of AKI (3-9%), subsequent analysis demonstrated an increase in the incidence to 15% 2, 3 . Suffolk County, New York was one of the hardest hit counties globally with over 40,000 confirmed SARS-CoV-2 cases and 1947 reported deaths 4 . Stony Brook University Medical Center is the largest academic medical center in the county and also managed the largest number of patients with COVID-19. In the midst of the COVID-19 pandemic from March 6, 2020, and May 11, 2020, the bed capacity at our academic medical center more than doubled, from 650 to 1317 beds capacity, including an additional 235 ICU beds. The physical space was gained by converting existing space in the main hospital, ambulatory surgical center, ambulatory care pavilion and other ambulatory care locations. During this period, a total of 2918 SARS-CoV-2 infected patients were seen in our Emergency Department, with 1580 patients discharged to home quarantine for recovery and 1338 patients admitted for hospitalization; 56 patients were ventilated. Approximately 22% developed AKI during their hospitalization, with 26% of J o u r n a l P r e -p r o o f these patients requiring KRT. During this period, we conducted a total of 729 hemodialysis and 354 continuous KRT (CKRT), averaging 12 hemodialysis and 6 CKRT sessions daily, with over 75% of cases requiring respiratory isolation due to COVID-19.

While we implemented measures such as shortened dialysis treatment in maintenance dialysis patients and urgent start peritoneal dialysis, this increased utilization of hemodialysis and CKRT placed a significant burden on our health care system, specifically our dialysis nursing staff, who were placed at a higher risk of exposure to SARS-CoV-2 during each dialysis treatment session at the patient's bedside.

To minimize the risk of exposure to nursing and staff while conducting dialysis treatments in COVID-19 isolation rooms, we postulated whether a remote telemonitoring strategy for dialysis treatments in patients with COVID-19 might reduce the overall risk of exposure to our staff. Since we were constrained for time during the pandemic, we were unable to test and optimize multiple telemonitoring platforms in the market.

However, we identified that baby monitors could serve as "ready-to-go" telemonitoring of patients on hemodialysis. At our academic center, we utilized the VTech Baby Monitor with a handheld seven-inch display monitor, high-definition 360-degree Camera

Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the