LAUSR

Patients receiving hemodialysis have to rely upon the institutions and personnel that provide their care. Those of us working within such institutions have a responsibility to maintain adequate infrastructure to meet patients’ needs, and to plan our response if unable to deliver these services. The Royal London Hospital (RLH) is the central hub in the Barts Health renal service, providing renal care to two million people in east London including hemodialysis for 1150 patients. Patients dialyze either at RLH or in one of six satellite units. Our service runs at close to 100% capacity, with virtually no empty slots to allow for contingencies. Renal services at the RLH are housed on the ninth floor of a 16-story tower opened in 2012, with a water purification plant providing ultrapure water for a total of 75 outpatient and 30 inpatient dialysis stations. On Saturday, April 23, 2022, the hospital suffered a loss of electrical power after a failure of switches occurred with a local power grid failure. The uninterruptable power supply provided power only for emergency lighting and critical areas such as the intensive care unit. A major incident was declared, and the hospital went into full command and control mode with an operational incident room operating. The hospital was closed to new admissions, and emergency services were put on standby to assist should a full evacuation be required. On the dialysis unit, power was lost shortly after all the morning patients had completed their dialysis sessions. In the afternoon, patients could not start dialysis and waited at the hospital for power to be restored. Around 4:30 P.M. on Saturday, as there was still no guarantee of a reliable power supply, a decision was made to send the 150 afternoon and twilight patients home to return for dialysis on Sunday, when ordinarily the units would be closed. The nursing staff kindly agreed to return on Sunday to provide care. Later on the Saturday, however, it was apparent that although power had been restored across the hospital, there was inadequate dialysis water pressure. The hospital estates team endeavored to identify the problem and by early Sunday morning, it became clear that a pressure surge caused by resumption of water pump activity had led to a rupture of the main pipe supplying water to the treatment plant on the tenth floor. A temporary repair was unsuccessful. An incident response group comprising senior renal doctors, dialysis nurses, and management staff made the early decision, at 9:00 A.M. on Sunday, to move all patients who should have been dialyzed on Saturday out to the satellite units. This was a major logistical challenge led by nursing staff in satellite dialysis units in close collaboration with hospital transport services. Minibuses, ambulances, and private cars were used to transport patients and nurses between sites, and a decision was made to accept shortened dialysis (2–3 h) in order to allow all patients to be dialyzed. By Sunday evening, all Saturday patients were thought to have received their treatment. However, the initial power failure had also caused the failure of electronic medical records which led to difficulties in Received: 5 August 2022 Accepted: 19 August 2022