Introduction
Portsmouth Hospitals NHS Trust ran a payment scheme for patients and relatives for transporting patients to their dialysis sessions during the COVID-19 outbreak. This was to support the local patient transport provider and enable them to manage during the COVID-19 outbreak while incentivising patients to make a potentially safer way into hospital than a multi pick up ambulance service.
The challenge
We were forecasting potentially significant numbers of COVID-19 suspected and positive patients still requiring regular dialysis but also isolation from their main dialysis session. We planned to isolate COVID-19 positive patients by using shifts on our main Portsmouth dialysis unit. The Trust supported us to build a wall to enable isolation as required and to enable us to grow our isolation space in a stepwise planned manner.
This meant that patients dialysis base would change while they were COVD-19 positive. It also meant they were near to the renal wards if their COVID-19 symptoms worsened while in having dialysis. We knew through modelling that we could manage even the worst case scenario though our plan without reducing patient dialysis schedules, however it would require location changes for patients testing positive for COVID-19.
This put pressure on the local patient transport service and they highlighted operational issues around changing dialysis locations. This was compounded by their own operational policies restricting the number of patients that could be transported in an ambulance at any one time. These policies were created to align to national guidance around social distancing, patient, and staff safety. This combination meant that it became clear another strategy was required that eased the pressure on the patient transport service and ensured all patients safely reached their dialysis session if they were COVID positive or not.
What we did
Amongst other plans we agreed that PHT would fund patients to make their own way into dialysis. This could either be by self driving or through a member of their household. We developed a script, and the local CCG phoned all patients to make the offer. These patients, if in agreement, consented to stop using PTS until the end of June 2020.
Once all patients had been asked, the details of those patients who had consented was sent to PTS and removed from the transport schedule until the end of June 2020. This in turn freed up PTS capacity to manage COVID-19 positive patients and keep capacity to manage the outbreak as it escalated while continuing to offer routine transport to those dialysis patients who required it.
The impact
Feedback has been positive with 53 patients taking up the service and costing £8,654 to date. The local patient transport service and the local commissioners have all requested the scheme is extended until the end of July 2020. We are in the process of organising this.