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Kidney Week

Abstract: FR-PO795

Post Hoc Ergo Propter Hoc: A Multilevel Strategy to Reduce 30-Day Readmissions in Patients on Dialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • O Brien, Frank J., Washington University in St. Louis, St. Louis, Missouri, United States
  • Sheikh, Sadaf Noor, Washington university St Louis MO, Valley Park, Missouri, United States
  • Vijayan, Anitha, Washington University in St. Louis, St. Louis, Missouri, United States

Patients with end-stage renal disease (ESRD) requiring dialysis are twice as likely as the general population to be readmitted within 30 days of hospital discharge. Inpatient care costs account for approximately 40% of total Medicare expenditures for dialysis. As of 2017, outpatient dialysis facilities have been penalized by the Centers of Medicare and Medicaid (CMS) for excessive readmissions as the standardized readmission ratio (SRR) became part of the ESRD quality incentive program. Our study examines the effect of a multi-level strategy to reduce readmission rates.


Washington University owns and operates 2 out-patient ESRD facilities in the city of St. Louis, with a census of approximately 400 patients. Using 2014-2017 data as our benchmark, we examine the impact of a dedicated transitional care nurse (TCN) and communication improvements (between the inpatient nephrology service and dialysis facilities) on readmission rates. The role of the TCN is to reconcile patient’s hospitalization with their outpatient care plan and bridge the gap from hospital to home. The TCN commenced work in the 3rd quarter of 2017.


Admission and 30 day readmission data are outlined below in table 1. Admissions and readmissions have been decreasing over the past 3 years. 30 day readmissions reduced since introduction of readmission prevention strategy. An influenza outbreak was responsible for the increased number of admissions in the first quarter of 2018. The TCN was able to see approximately 50% of patients within 48 hours of discharge and the patient's nephrologist saw 90% of patients within one week of discharge.


This study highlights the ongoing difficulty dialysis units have with reducing readmission rates. We show that increased patient engagement with a TCN in the first 48 hours post discharge and improved structured communication between in patient nephrology services and dialysis facilities has led to reduced rates of readmissions.

Table 1
 Pre intervention  Intervention    
 2014201520162017 (1st quarter)2017 (2nd quarter)2017 (3rd quarter)2017 (4th quarter)2018 (1st quarter)
Admissions (n)713889634148133126125151
Readmissions (%)3234313230262322


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