Dialysis Clinic

Process Improvement AnalysisAdam Roy Dorothy FisherJanelle BryantJoel MikutaSherri MesquitaMichelle Himes

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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.

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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

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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?