Abstract: SA-PO971
High-Frequency, Distinctive Staffing and Outcomes: Improving the Dialysis Experience
Session Information
- Hemodialysis and Frequent Dialysis - V
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Lauar, Juliane, Centro Brasiliense de Nefrologia & Dialise, Brasilia, DISTRITO FEDERAL, Brazil
- Lins, Luiza, Centro Brasiliense de Nefrologia & Dialise, Brasilia, DISTRITO FEDERAL, Brazil
- Xavier, Kelia, Centro Brasiliense de Nefrologia & Dialise, Brasilia, DISTRITO FEDERAL, Brazil
- Bello, Vilber, Centro Brasiliense de Nefrologia & Dialise, Brasilia, DISTRITO FEDERAL, Brazil
- Simon, Adolfo, Centro Brasiliense de Nefrologia & Dialise, Brasilia, DISTRITO FEDERAL, Brazil
- Pascoal, Istenio, Centro Brasiliense de Nefrologia & Dialise, Brasilia, DISTRITO FEDERAL, Brazil
Group or Team Name
- Centro Brasiliense de Nefrologia & Dialise
Background
Frequent dialysis has consistently improved patient outcomes. Professional staffing of dialysis affects patient care quality and safety. Requirements for physician presence during dialysis and for nursing staff levels are highly variable worldwide. We have set up a 24-stations in-center short daily hemodialysis (SDHD) program whose all day long care is provided by two on-site nephrologists, certified nurses, renal dietitians and psycologists with fulltime dedication. This report outlines the impact of 10 years of combining daily hemodialysis with selected clinical staffing on patient outcomes.
Methods
Nephrologist schedule, patient to staff ratios, adverse events rates (hypotension, medication errors, patient falls), vascular access profile (type, infection rates), patient compliance (missed treatment rate), hospitalization (days per patient-year [pp-y]), cumulative survival and kidney transplantation rates were assessed in 200 private-insured patients (122M/78F; mean age 58.0±18.5yrs, 18-96) receiving in-center SDHD (6-7 x/wk; lasting 115.4±11.2min, 90-180; ultrapure dialysate and single-use high-flux dialyzer).
Results
From June 2009 to May 2019 four out 5 nephrologists shared equitable schedule 7 days/wk, each one prescribing up to 24 patients in 2 parallel and 2 sequential 6-hour workday. In 2009 we stopped hiring technicians and moved to 100% nurses staffing, reaching 21 fulltime certified nurses (up to 3:1 ratio). Additionaly, 2 dietitians and 2 psycologists assist 80 current patients (40:1 ratios). In 2018 symptomatic hypotension occurred in 3% of 20,035 treatments, medication errors in 17 occasions (none critical) and no patients fell in the unit. Over the 10-year study period, arteriovenous fistula was used in 53% and tunneled catheter in 47% of prevalent patients, with bacteremia rate of 0.27 and 0.50 events per 1,000 days. Missed treatment rate was 1.49% or 4.6 days pp-y. Hospital length of stay was 2.9 days pp-y, 5-year survival was 64% and average kidney transplantation rate was 7.5%. Duplicating nephrologist presence and replacing technicians with certified nurses doubled labor costs, largely offset by higher productivity (five 2-hour shifts/day) and longer dialysis vintage.
Conclusion
This intensive dialysis modality delivered by a first-rate clinical staffing represents an unparalleled approach toward an optimal treatment.