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Abstract: TH-PO275

Fast Track Dialysis: A Novel Triage and Communication Pathway to Reduce Resource Utilization for ESRD Patients Presenting with Missed HD

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Masud, Tahsin, Emory University , Atlanta, Georgia, United States
  • Molitch-Hou, Ethan, Emory University Hospital Midtown, Atlanta, Georgia, United States
  • James, Kyle P., Emory University Hospital Midtown, Atlanta, Georgia, United States
  • O'Donnell, Christopher M., Emory University Hospital Midtown, Atlanta, Georgia, United States
Background

Many end stage renal disease (ESRD) patients present to emergency department (ED) with complaints related to missed hemodialysis (HD) or have no established dialysis clinic. Provision of inpatient HD necessitates short stay admission, use of extra resources, coordination between multiple specialties, resulting in substantial cost.

Methods

A multidisciplinary team sought to improve the flow of ESRD patients through the ED by creating a unique triage pathway, Fast Track Dialysis (FTD). FTD care was facilitated with standardized communication between ED, Nephrology, Hospitalist and Nursing. The FTD pathway emphasized use of venous blood gasses for potassium levels, limited telemetry, chest X-ray, and peripheral IV lines.
Patients eligible for FTD were identified by ED providers. Exclusions were BP > 200/100, heart rate > 120/ minute, hypoxia requiring oxygen > 4 L/min , potassium > 6.5 mEq/L and clinical concern that would require admission beyond one session of HD, and dialysis access issues requiring immediate intervention. A six-month historical control group (Pre-FTD) was compared with a six-month FTD cohort with hospital stay < 48 hours. The historical group was filtered by admitting diagnosis (ICD-10 codes) related to dialysis conditions, stay < 48 hours, and above exclusion criteria.
Outcome measures were time parameters from triage to ED discharge, HD start, and hospital discharge. The estimates of cost were obtained from hospital generated billing.

Results

FTD led to significant reduction in all time parameters studied (Table). The billing cost was lower but reached significance level after excluding 3 outliers who require additional diagnostic testing for head injury, paracentesis and chest pain.

Conclusion

The implementation of a novel patient care pathway intended to identify, triage, and facilitate the care of low risk ESRD patients that required urgent HD led to a reduction in resource utilization.

 Pre-FTD (1/1/17-6/30/17)95% CIFTD (9/25/17-3/16/18)95% CIp-valvue
Age, years(SD)58.6 (13.2) 53.2 (10.1) <0.01
Males, n(%)44 (53.7) 52 (68.4) 0.23
Triage to ED discharge (Hrs)7.25.90-8.434.13.34-4.83<0.01
Triage to HD start (Hrs)12.89.15-16.65.23.52-6.86<0.01
Triage to hospital discharge (Hrs)26.224.28-28.0514.312.4-25.40.01
Billing cost (x1000 dollars)31.5130.29-32.7224.1522.91-25.39<0.01