Harbor:Scheduled dialysis patients in ED

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COVID Transitional Dialysis

  • Up to 30 days after hospital DC while awaiting transition to community dialysis centers; re-admit after day 28 if not transitioned
    • max 2 pt/shift, M/W/F, 8:30 a.m.-1230 p.m. and 1-30 p.m.-5:30 p.m.
      • repeat test every 7-10d at HD even if asymptomatic
    • COVID neg on admission - test q7d, Keck
    • recovered >10d no symptoms (do not re-test within 30d of last covid test) - upstairs … IPC expected practice coming soon
    • Symptomatic or /COVID positive - HD in ED
    • Hep neg <30d … repeat q30d

1) inpatient who was COVID (-) in house - no retest. 2) if previously COVID (+) and recovered per our EP, can go to the unit after discharge (coming in from home) – no retest 3) if ever develops new symptoms, must be dialyzed in ED unless, at least, tested and clinical determination made with results known


  • ED Flow
    • call from Dialysis Area Clerk to OCN
    • OCN to place pre-arrival note
    • Pt arrives with "dialysis ticket" (given by dialysis team prior to previous DC)stating here for scheduled emergent HD
    • MSE - "Pt here for emergent HD; no other medical concerns; hemodynamically stable for HD"
    • USA takes to Transitional HD center
    • ED/Transitional Dialysis Unit (5 West Room 10)
      • symptomatic/COVID positive/Hep B - A15, R19, G29, Tra1
    • After dialysis completed, HD nurse to write brief note stating that session completed and patient is stable
      • Perform documented dialysis treatment/documentation as ordered
      • Perform documented post-treatment assessment and discharge education/instruction
      • Place a procedure note in ORCHID post treatment
    • after HD - DC from FT with "Hemodialysis" instructions
    • if hemodynamically unstable after HD, return to ED for evaluation
  • Dialysis nurses to request transport service to transport patient back to ER for patients completing dialysis if needed or for patients needing to return to ED for management.
  • If symptomatic can use 1-hr test to avoid admission
  • Patients empaneled to HD centers but new covid positive get admitted … may use transitional for this in the future






OLD PROCESS from 12-2017

  1. The router will place them on the pre-arrivals each AM (M/W/F)
  2. HD times should be 5-9a and 930-130p
  3. They will receive a MSE at triage – if they decline the MSE and only want their scheduled HD, please document that “the patient declined a MSE and no emergent medical condition exists at this time” in the MSE note and we are done from the ED perspective
  4. If the patient appears unstable, please discuss with one of the AED attendings to determine if they need to be on an AED team or simply need dialysis with a call to the nephrologist for urgent evaluation.
  5. Once the MSE is performed, they will be taken to one of our HD rooms – preferentially Gold 29, then RME 19, then Acute 15 (likely a max of 2 rooms at a time).
  6. They will be cared for by the nephrologist (typically Dr. Anuja Shah) who will place the discharge orders (so these patients should NOT be placed on AED teams).
  7. If for some reason Dr. Shah is unable to evaluate the patient prior to discharge, the FastTrack NP (not resident) will briefly evaluate the patient when ready for discharge - documenting vitals, heart, lung, and lower extremity exam, and page Dr. Shah to clear for dispo and subsequently print the discharge instructions (“HEMODIALYSIS” patient education).
  8. The NP will forward the chart to Dr. Shah, not ED R4 or Attending.


See Also

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