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Dialysis Clinic
Process Improvement AnalysisAdam Roy Dorothy FisherJanelle BryantJoel MikutaSherri MesquitaMichelle Himes
2
Dialysis Overview
60% of Dialysis patients are ambulatory and are transported by way of ambulatory services
The majority of patients are Medicare vs. Medicaid
Each patient’s treatment at the clinic is about 3-4 hours, 2 to 3 days per week.
3
Types of Treatment Areas
Hemodialysis -is the most common way to treat advanced kidney failure.
The blood is pumped out of your body to an artificial kidney
Requires patient to follow a strict treatment schedule, take medications and, usually, make changes in diet.
Treatment Area Peritoneal Dialysis-Peritoneal dialysis
(PD) has been a widely accepted method of treating end stage renal disease (ESRD) the most common method of home dialysis.
While many dialysis patients in the United States go to a dialysis center, PD offers more flexibility by allowing patients to dialyze at home, at work or on vacation.
Patient Treatment Needs
Patients have a team of Nurses, Dietician, and Social Worker
Fluid Restriction
Patients have a strict Kidney Diet
Current State Process
Common Process “Pain Points”
Issue # 1Incidence of bloodstream infections related to dialysis treatment
Bacterial infections are most common type37,000 infections annually in the U.S.$23,000 per related hospitalization
Issue # 2Extended patient wait times for treatment
Creates a domino effect for other patientsIncreases clinic staff stress level
Leads to errors and often further delays
Process Improvement/SolutionsIssue # 1Incidence of bloodstream infections related to dialysis treatmentSolutionDevelopment /implementation of staff-level checklists at key points where infections can occur
CDC-recommendedRequires active management oversight and
auditing to ensure staff complianceFacilitate staff training around the need to follow proper protocols relative to venous site infection prevention
Issue # 2Extended patient wait times for treatmentSolutionImplement process workflow reengineering utilizing “lean” principlesLimit # of patients beginning treatment at any given time
# is dependent on clinic sizeCritical to manage patient expectationsRoutinely audit process for course corrections
Facilitate staff training around the need to stagger patient appointment times
Process Improvement/Solutions (Cont’d)
Future State Process
Process enhancement points
11
Performance Metrics
Issue # 1Incidence of bloodstream infections related to dialysis treatmentMeasurement (A): # of catheter-site infections vs. current baselineFrequency: Metric calculated and reported to the National Healthcare Safety Network (NHSN) and appropriate clinic staff members every 30 daysGoal: Reduce infection rate by 50% within the initial 60 days
Measurement (B): Auditing of recommended practices around central venous catheter care, minimum scrub and soaking time for antispetics and proper hand hygiene/gloving practicesFrequency: Monthly observational audits and staff re-training on an as-needed basisGoal: Conduct at a minimum one formal audit each 30 days and informal audits on an on-going basis
Performance MetricsIssue # 2Extended patient wait times for treatmentMeasurement (A): Average patient wait time to begin treatment vs. current baselineFrequency: Metric calculated monthly and reported to appropriate staff members every 30 daysGoal: Reduce average wait time by 30% within the initial 30 days and 50% within 60 daysMeasurement (B): Patient customer satisfaction levels (specific to treatment wait times), as reported by a random survey distributed each weekFrequency: Metric calculated monthly and reported to appropriate staff members every 30 daysGoal: Increase patient satisfaction rates around wait time by 50% in terms of favorable responses versus baselineMeasurement (C): Staff satisfaction/stress levels, as reported by a self-reporting survey Frequency: Metric calculated monthly and reported to appropriate staff members every 30 daysGoal: Increase overall staff job satisfaction level by 25% (30 days) and 50% (90 days) versus baseline
Conclusions Dialysis clinics serve a critical need for a sensitive
patient population
Key process improvements can be centered around:Customer service (reduced wait times/delays)Patient safety (reduced catheter site infections)Staff job satisfaction (reduced self-reported
stress levels)
Routine monitoring/reporting/training is critical to ensuring the above improvements remain impactful moving forward
Reference Material
http://www.nephrologynews.com/articles/109727-how-applying-lean-principles-in-dialysis-improved-efficiency-and-patient-satisfaction
Questions?