Renal unit, QEH finances, staff burdened by growing number of dialysis patients

The renal unit at the Queen Elizabeth Hospital (QEH) is under severe pressure, with at least five new patients going on dialysis every week and inadequate staff to provide the necessary care.

Resident Nephrologist at the QEH, Dr Lisa Belle, fellow Nephrologist Dr Nerissa Jurawan, and nurse Sister Maureen Butcher lamented that managing the growing number of dialysis patients was overburdening the unit.

The hospital, meantime, has been spending millions of dollars annually to treat patients with chronic and acute kidney disease.

The concerns were raised during the QEH virtual roundtable discussion on Addressing Renal Disease in Barbados: The Path Forward, at which the hospital’s Director of Finance Adrian Hurley said the institution was feeling the financial pressure of an increasing number of patients needing dialysis.

Dr Belle said there are 182 patients receiving dialysis at the hospital, while 122 patients, through the QEH, were getting treatment at outsourced facilities.

She added that there were over 1 000 chronic kidney disease patients who were treated through an extensive renal clinic, with between 50 to 70 patients being seen on Thursdays.

Unfortunately, Dr Belle said, the nature of the renal clinic was such that patients who were referred hardly get discharged.

“So, we just accrue patients and from that population, a significant number will transition to dialysis eventually, as their disease progresses,” the nephrologist said.

She indicated that while the unit sees a large number of patients, there were limited physicians and nurses to care for them.

Dr Belle noted that while consultants are compensated for 21 hours per week, they have been working 41 hours.

“So, how are we doing? Not very well. The turnover of patients is very large and I think we have a higher morbidity and mortality rate, and this is only speaking off the top of my head because I have no data, no time to collect data, no resources to collect data,” she said.

“I think our numbers are more than we would like to see, mainly because we don’t have the manpower and the time to do all the things that need to be done for this complex set of patients. When you look at places abroad, a multidisciplinary team is absolutely necessary to manage the medical, nursing, social aspect, pharmacy, dietary, nephrologists,” she added.

Dr Jurawan echoed Dr Belle’s concern that the department was overwhelmed, and said there was a need to screen individuals for early signs of renal disease to get the situation under control.

She noted that the Artificial Kidney Unit at the QEH services both chronic and acute patients, which makes it a complicated environment to work in.

However, the specialist suggested, patients with chronic renal failure should be placed in a satellite unit to allow those who need acute care to get the dialysis treatment they need to be discharged sooner.

“Currently, our burden for the acute kidney injury is that we roughly see 30 to 40 patients per week throughout the entire hospital and out of that number, at least five patients per week start dialysis. They are crash landers. They present to hospital not knowing that they ever had kidney disease and they have to start dialysis. So it’s a huge burden on the hospital system,” Dr Jurawan said.

“So, I am appreciative that everyone recognises the fact that we need screening. I think that is the key to a sustainable management plan for kidney disease. We need to get out there and screen and stop what we are seeing presenting to the hospital,” she added.

Meanwhile, Hurley disclosed that dialysis was responsible for between 65 and 70 per cent of the QEH’s outsourced medical services, at a cost of approximately $6 million.

“It is very concerning because it takes up a significant part of our budget and it seems to be climbing every year,” he said.

Nurse Butcher, who also works in the renal unit, stressed that the department was operating with an insufficient 11 nurses working three shifts.

“The nurses are not certified dialysis nurses and they are working extremely hard. Our nurses are on call, but they are only paid when they are called out,” Butcher said. anestahenry@barbadostoday.bb