Management of Canadian Pediatric Patients With Glomerular Diseases During the COVID-19 Pandemic: Recommendations From the Canadian Association of Pediatric Nephrologists COVID-19 Rapid Response Team

Purpose: The goal of these recommendations is to provide guidance on the optimal care of children with glomerular diseases during the COVID-19 pandemic. Patients with glomerular diseases are known to be more susceptible to infection. Risk factors include decreased vaccine uptake, urinary loss of immunoglobulins, and treatment with immunosuppressive medications. The Canadian Society of Nephrology (CSN) recently published guidelines on the care of adult glomerulonephritis patients. This guideline aims to expand and adapt those recommendations for programs caring for children with glomerular diseases. Sources of information: We used the CSN COVID-19 Rapid Response Team adult glomerulonephritis recommendations, published in the Canadian Journal of Kidney Health and Disease, as the foundation for our guidelines. We reviewed documents published by nephrology and non-nephrology societies and health care agencies focused on kidney disease and immunocompromised populations. Finally, we conducted a formal literature review of publications relevant to pediatric and adult glomerular disease, chronic kidney disease, hypertension, and immunosuppression in the context of the COVID-19 pandemic. Methods: The leadership of the Canadian Association of Pediatric Nephrologists (CAPN), which is affiliated with the CSN, identified a team of clinicians and researchers with expertise in pediatric glomerular diseases. The aim was to adapt Canadian adult glomerulonephritis guidelines to make them applicable to children and discuss pediatric-specific considerations. The updated guidelines were peer-reviewed by senior clinicians with expertise in the care of childhood glomerular diseases. Key findings: We identified a number of key areas of glomerular disease care likely to be affected by the COVID-19 pandemic, including (1) clinic visit scheduling, (2) visit types, (3) provision of multidisciplinary care, (4) blood work and imaging, (5) home monitoring, (6) immunosuppression, (7) other medications, (8) immunizations, (9) management of children with suspected COVID-19, (10) renal biopsy, (11) patient education and support, and (12) school and child care. Limitations: There are minimal data regarding the characteristics and outcomes of COVID-19 in adult or pediatric glomerular disease patients, as well as the efficacy of strategies to prevent infection transmission within these populations. Therefore, the majority of these recommendations are based on expert opinion and consensus guidance. To expedite the publication of these guidelines, an internal peer-review process was conducted, which may not have been as rigorous as formal journal peer-review. Implications: These guidelines are intended to promote optimal care delivery for children with existing or newly diagnosed glomerular diseases during the COVID-19 pandemic. The implications of modified care delivery, altered immunosuppression strategies, and limited access to existing resources remain uncertain.

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Inside the Mind of a Rapid Response Activator

10.28971/532011mg55 ◽

2011 ◽

Author(s):

Gail Mosher

Keyword(s):

Care Delivery ◽

Rapid Response Team ◽

Health Care Delivery System ◽

Rapid Response ◽

Staff Nurse ◽

Structured Interviews ◽

Surgical Nurses ◽

Response Team ◽

The Mind ◽

Study Participants

<p>The health care delivery system in this nation continues to spiral out of control. Statistics report on the shocking number of people who are harmed or die due to medical errors. This project will focus on one process in the armamentarium, the Rapid Response Team (RRT). The purpose of the study was to explore staff nurse perceived barriers and enhancers to an effective RRT. Qualitative design was employed and individual semi-structured interviews were conducted at a 359 bed community hospital. The sample consisted of 15 medical-surgical nurses who had experienced a rapid response (RR) event at this site. Potential subjects were excluded if they had worked in the emergency department or a critical care unit or if they stated a belief that they had not been significantly affected by a RR event. Findings showed that the study participants were exceptionally appreciative of their RRT. They encountered minimal barriers and shared some poignant suggestions that may make valuable contributions to the institution's RRT. Participants expressed a significant desire for more education to develop their self-efficacy and skills in these emergency events. Conclusions and implications for advanced practice are identified and discussed.</p>

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The CSN COVID-19 Rapid Response Program

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120949110 ◽

2020 ◽

Vol 7 ◽

pp. 205435812094911

Author(s):

Gihad Nesrallah ◽

Loreen Gilmour ◽

Adeera Levin ◽

Reem Mustafa ◽

Steven Soroka ◽

...

Keyword(s):

Kidney Disease ◽

Methodological Approach ◽

Kidney Injury ◽

Rapid Response Team ◽

Rapid Response ◽

Rapid Review ◽

Home Dialysis ◽

Published Evidence ◽

Response Team ◽

Guidance Documents

The coronavirus disease (COVID-19) pandemic has created unprecedented challenges in caring for individuals living with kidney disease. In response to a growing call for up-to-date information and evidence-informed advice, the Canadian Society of Nephrology has established a COVID-19 Rapid Response Team that will leverage existing evidence and national expertise to inform kidney care practices in the COVID-19 era. Given limited published evidence and compressed timelines, formal clinical practice guidelines are not feasible, and we have adopted rapid review methods to instead provide interim guidance across identified priority areas. In this article, we describe the methodological approach that was applied in developing a first iteration of guidance documents addressing clinical and operational aspects of care for patients treated with in-center hemodialysis, home dialysis, those with advanced chronic kidney disease, those with glomerulonephritis, and those with acute kidney injury. We further describe strategies for maintaining ongoing engagement with the renal community to elicit emerging needs and perspectives as the situation unfolds.

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Management of Outpatient Hemodialysis During the COVID-19 Pandemic: Recommendations From the Canadian Society of Nephrology COVID-19 Rapid Response Team

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120938564 ◽

2020 ◽

Vol 7 ◽

pp. 205435812093856

Author(s):

Rita S. Suri ◽

John E. Antonsen ◽

Cheryl A. Banks ◽

David A. Clark ◽

Sara N. Davison ◽

...

Keyword(s):

Public Health ◽

Peer Review ◽

Review Process ◽

Peer Review Process ◽

Rapid Response Team ◽

Adverse Outcomes ◽

Rapid Response ◽

Canadian Society ◽

Dialysis Unit ◽

Response Team

Purpose: To collate best practice recommendations on the management of patients receiving in-center hemodialysis during the COVID-19 pandemic, based on published reports and current public health advice, while considering ethical principles and the unique circumstances of Canadian hemodialysis units across the country. Sources of information: The workgroup members used Internet search engines to retrieve documents from provincial and local hemodialysis programs; provincial public health agencies; the Centers for Disease Control and Prevention; webinars and slides from other kidney agencies; and nonreviewed preprints. PubMed was used to search for peer-reviewed published articles. Informal input was sought from knowledge users during a webinar. Methods: Challenges in the care of hemodialysis patients during the COVID-19 pandemic were highlighted within the Canadian Senior Renal Leaders Forum discussion group. The Canadian Society of Nephrology (CSN) developed the COVID-19 rapid response team (RRT) to address these challenges. They identified a pan-Canadian team of clinicians and administrators with expertise in hemodialysis to form the workgroup. One lead was chosen who drafted the initial document. Members of the workgroup reviewed and discussed all recommendations in detail during 2 virtual meetings on April 7 and April 9. Disagreements were resolved by consensus. The document was reviewed by the CSN COVID-19 RRT, an ethicist, an infection control expert, a community nephrologist, and a patient partner. Content was presented during an interactive webinar on April 11, 2020 attended by 269 kidney health professionals, and the webinar and first draft of the document were posted online. Final revisions were made based on feedback received until April 13, 2020. CJKHD editors reviewed the parallel process peer review and edited the manuscript for clarity. Key findings: Recommendations were made under the following themes: (1) Identification of patients with COVID-19 in the dialysis unit, (2) hemodialysis of patients with confirmed COVID-19, (3) hemodialysis of patients not yet known to have COVID-19, (4) visitors; (5) testing for COVID-19 in the dialysis unit; (6) resuscitation, (6) routine hemodialysis care, (7) hemodialysis care under fixed dialysis resources. Limitations: Because of limitations of time and resources, and the large number of questions, formal systematic review was not undertaken. The recommendations are based on expert opinion and subject to bias. The parallel review process that was created may not be as robust as the standard peer review process. Implications: We hope that these recommendations provide guidance for dialysis unit directors, clinicians, and administrators on how to limit risk from infection and adverse outcomes, while providing necessary dialysis care in a setting of finite resources. We also identify a number of resource allocation priorities, which we hope will inform decisions at provincial funding agencies.

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Faculty Opinions recommendation of Hospital-wide code rates and mortality before and after implementation of a rapid response team.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1135962.593069 ◽

2008 ◽

Author(s):

Michael O'Connor

Keyword(s):

Rapid Response Team ◽

Rapid Response ◽

Before And After ◽

Response Team

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Mise en place et organisation d’une équipe médicale mobile de réponse précoce aux urgences intra-hospitalières (Rapid Response Team)

Médecine Intensive Réanimation ◽

10.37051/mir-00018 ◽

2020 ◽

Author(s):

Boris Jung ◽

Gerald Chanques ◽

Samir Jaber ◽

Kada Klouche

Keyword(s):

Rapid Response Team ◽

Rapid Response ◽

Prise En Charge ◽

Response Team

La mise en place d’une Rapid Response Team a pour objectif la mise en place d’une structure de réponse hospitalièrepour la prise en charge des urgences vitales et surtout une réponse précoce à la dégradation clinique des patientshospitalisés avant que l’urgence vitale ne survienne. Nous discutons dans ce manuscrit le rationnel et le niveau depreuve motivant la mise en place d’une Rapid Response Team ainsi que les freins qui doivent être surmontés pour lesuccès de cette mise en place.

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