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Abstract: PO1266

A Snapshot for Peritoneal Dialysis Clinic Visits: Addressing Hospitalization Rates with a Checklist

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Saggese, Samantha M., Northwestern Memorial Hospital, Chicago, Illinois, United States
  • Jain, Aditya Vikram, Northwestern Memorial Hospital, Chicago, Illinois, United States
  • Bond, Michael, Northwestern Memorial Hospital, Chicago, Illinois, United States
  • Cho, Janis, Northwestern Memorial Hospital, Chicago, Illinois, United States
  • Leidner, Alexander S., Northwestern Memorial Hospital, Chicago, Illinois, United States
  • Samuel, Tina S., Northwestern Memorial Hospital, Chicago, Illinois, United States
  • Gurram, Harini, Northwestern Memorial Hospital, Chicago, Illinois, United States
  • Aggarwal, Vikram, Northwestern Memorial Hospital, Chicago, Illinois, United States
Background

Readmission rates are a component of quality metrics in home dialysis follow-up. Common causes of peritoneal dialysis (PD) related hospitalizations have been elucidated through National Readmission Database review. However, a systematic approach to identify individual risk factors leading to the index hospitalization and targeted interventions are not directly designed into clinic workflow. Often information regarding these specific risk factors are not exacted. We identified a need to standardize practice in our PD clinic by conceiving an action checklist for nephrologists and nurses to minimize index admissions.

Methods

Our quality improvement project sought to identify risk factors by analyzing the cause of admission from our cohort of 103 PD patients over 8 months. We divided reasons for admission into related and unrelated to PD. Based on these categories, we created a list of potential contributory risk-factors for admission. We also surveyed providers to determine key clinical components for a clinic checklist to encourage early recognition of the risk-factors.

Results

Of the 105 individual admission events identified from June 2018 to March 2019, 45% were identified as PD-related. Such admissions included peritonitis (34%), hypervolemia (19%), electrolyte derangement (13%), hypotension (13%), hypertension (10.6%) and catheter dysfunction (10.6%). 37 admissions (35%) were readmissions in the last 30 days, of which 60% were PD-related. From these results we designed a snapshot of trends of the prior 3 months’ vital signs, electrolytes, weights, PET results, PD adequacy results, urine volume, peritonitis history and current medications for clinicians to review pre-visit.

Conclusion

We are currently implementing this checklist in our monthly PD clinic visits. Though the idea was conceived prior to the pandemic, we have increasingly seen the benefit of a clinical trends snapshot readily available as we transition to Telehealth visits to prevent patients’ exposure to COVID-19. This method assists the clinician in triaging remotely. Ultimately, through utilization of this tool, we hope to unify our practice pattern in the clinic to reduce admission rates by prompting proactive, not reactive, interventions.