7 Case ascertainment and cohorting

7 Case ascertainment and cohorting

7.1 Screen and triage all patients attending dialysis units to assess whether they are known or suspected to have COVID‑19, or have been in contact with someone with confirmed COVID‑19. If a patient is not thought to be at risk of COVID‑19, no additional precautions are needed.

7.2 Set up and review facilities to minimise cross-infection so that patients can be dialysed in cohorts based on their COVID‑19 status. Think about whether anyone accompanying a patient to the dialysis unit may have COVID‑19, and cohort the patient appropriately.

7.3 If possible, have separate entrances for patients who do not have COVID‑19 and for patients known or suspected to have COVID‑19.

7.4 Ensure dialysis scheduling can properly accommodate the cleaning needs for any cohorted areas that have been established within the dialysis units.

Before patients enter the unit for dialysis

7.5 Screen and triage patients before they enter the dialysis unit (for example, at the reception waiting area).

7.6 If patients are suspected to have COVID‑19, where possible, do rapid turnaround testing before dialysis to establish COVID‑19 status. Dialysis may be needed before the test results are available. If the cohort status of a patient changes based on the results, manage according to the relevant cohort status. For more information see the UK government guidance on sampling and for diagnostic laboratories.

7.7 In patients suspected of having COVID‑19, as a minimum:

  • swab for COVID‑19

  • assess for alternative causes of symptoms

  • assess whether dialysis could be delayed until their COVID‑19 status is known.

7.8 If a patient is COVID‑19 negative and has symptoms, ensure that other explanations for the symptoms have been considered and treated. At subsequent assessment, retest the patient if there is still a clinical suspicion of COVID‑19.

7.9 Patients known to have COVID‑19 should remain in this cohort for 7 days from the start of symptoms, or until they have recovered if this is longer.

7.10 Patients should continue to be treated as close to home as possible. Inform them that they may need to be moved to other units to allow effective cohorting.

7.11 If there is limited service capacity because of COVID‑19 and dialysis schedules need to be modified:

  • make decisions as part of a multidisciplinary team and consider each patient on an individual basis

  • ensure the reasoning behind each decision is recorded

  • clearly communicate to patients, their families and carers what rescheduling involves, the reason for the decision, and the risks and benefits.