Abstract: SA-PO966
A Quality Improvement Program to Reduce Avoidable Hospital Stays for Dialysis Patients Presenting to the Emergency Department
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
- Wong, Tiffany, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Lejbman, Julian M., Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Snider, Christopher Keith, Penn Medicine , Philadelphia, Pennsylvania, United States
- Porges, Stefanie B., Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Shah, Siddharth P., Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background
When an End Stage Kidney Disease (ESKD) patient presents to the ED, if he/she requires dialysis, this may result in a costly hospital stay. In Fiscal Year 2017 at the Hospital of University of Pennsylvania, 70% of ESKD patients who presented to the ED were admitted to an inpatient service or transferred to the ED observation unit (EDOU) and 31% of these hospital stays were <48 hours. We believe hospital stays <48 hours can be potentially avoidable.
Methods
A multidisciplinary team was formed with members from the departments of nephrology and emergency medicine (EM). We used Voice of the Customer to survey key stakeholders (RNs, advanced practitioners, residents, attendings, social workers, clinical resource coordinators, and representatives from large dialysis organizations). We performed a root cause analysis using the Ishikawa fishbone model. As a countermeasure, we developed a care pathway to standardize management of patients’ dialysis needs, with dialysis provided in the hospital before discharge or as an outpatient (introduced July 2018). A second plan-study-do-act cycle was performed in November 2018. New countermeasures included an alert identifying the patient as a dialysis patient with specific dialysis unit information and working with the hospitalist superutilizer program to identify additional dialysis patients appropriate for the program.
Results
After introduction of the care pathway, hospital stays <48 hours decreased from 31% to 22% and transfers from the ED to EDOU from 28% to 20%.
Conclusion
By utilizing QI tools and developing a care pathway as a countermeasure, we were able to decrease the percent of hospital stays <48 hours, which we believe represent potentially avoidable hospital stays.